[United States Statutes at Large, Volume 122, 110th Congress, 2nd Session]
[From the U.S. Government Publishing Office, www.gpo.gov]

122 STAT. 2918

Public Law 110-293
110th Congress

An Act


 
To authorize appropriations for fiscal years 2009 through 2013 to
provide assistance to foreign countries to combat HIV/AIDS,
tuberculosis, and malaria, and for other purposes. [NOTE: July 30,
2008 -  [H.R. 5501]]

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress [NOTE: Tom Lantos and Henry J.
Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act of 2008. 22 USC 7601 note.] assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

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

TITLE I--POLICY PLANNING AND COORDINATION

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

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

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

TITLE III--BILATERAL EFFORTS

Subtitle A--General Assistance and Programs

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

TITLE IV--FUNDING ALLOCATIONS

Sec. 401. Authorization of appropriations.

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122 STAT. 2919

Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.

TITLE V--MISCELLANEOUS

Sec. 501. Machine readable visa fees.

TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

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

SEC. 2. FINDINGS.

Section 2 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by
adding at the end the following:
``(29) On May 27, 2003, the President signed this Act into
law, launching the largest international public health program
of its kind ever created.
``(30) Between 2003 and 2008, the United States, through the
President's Emergency Plan for AIDS Relief (PEPFAR) and in
conjunction with other bilateral programs and the multilateral
Global Fund has helped to--
``(A) provide antiretroviral therapy for over
1,900,000 people;
``(B) ensure that over 150,000 infants, most of whom
would have likely been infected with HIV during
pregnancy or childbirth, were not infected; and
``(C) provide palliative care and HIV prevention
assistance to millions of other people.
``(31) While United States leadership in the battles against
HIV/AIDS, tuberculosis, and malaria has had an enormous impact,
these diseases continue to take a terrible toll on the human
race.
``(32) According to the 2007 AIDS Epidemic Update of the
Joint United Nations Programme on HIV/AIDS (UNAIDS)--
``(A) an estimated 2,100,000 people died of AIDS-
related causes in 2007; and
``(B) an estimated 2,500,000 people were newly
infected with HIV during that year.
``(33) According to the World Health Organization, malaria
kills more than 1,000,000 people per year, 70 percent of whom
are children under 5 years of age.
``(34) According to the World Health Organization, \1/3\ of
the world's population is infected with the tuberculosis
bacterium, and tuberculosis is 1 of the greatest infectious
causes of death of adults worldwide, killing 1,600,000 people
per year.
``(35) Efforts to promote abstinence, fidelity, the correct
and consistent use of condoms, the delay of sexual debut, and
the reduction of concurrent sexual partners represent important
elements of strategies to prevent the transmission of HIV/AIDS.
``(36) According to UNAIDS--
``(A) women and girls make up nearly 60 percent of
persons in sub-Saharan Africa who are HIV positive;
``(B) women and girls are more biologically,
economically, and socially vulnerable to HIV infection;
and
``(C) gender issues are critical components in the
effort to prevent HIV/AIDS and to care for those
affected by the disease.
``(37) Children who have lost a parent to HIV/AIDS, who are
otherwise directly affected by the disease, or who live

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122 STAT. 2920

in areas of high HIV prevalence may be vulnerable to the disease
or its socioeconomic effects.
``(38) Lack of health capacity, including insufficient
personnel and inadequate infrastructure, in sub-Saharan Africa
and other regions of the world is a critical barrier that limits
the effectiveness of efforts to combat HIV/AIDS, tuberculosis,
and malaria, and to achieve other global health goals.
``(39) On March 30, 2007, the Institute of Medicine of the
National Academies released a report entitled `PEPFAR
Implementation: Progress and Promise', which found that budget
allocations setting percentage levels for spending on
prevention, care, and treatment and for certain subsets of
activities within the prevention category--
``(A) have `adversely affected implementation of the
U.S. Global AIDS Initiative';
``(B) have inhibited comprehensive, integrated,
evidence based approaches;
``(C) `have been counterproductive';
``(D) `may have been helpful initially in ensuring a
balance of attention to activities within the 4
categories of prevention, treatment, care, and orphans
and vulnerable children';
``(E) `have also limited PEPFAR's ability to tailor
its activities in each country to the local epidemic and
to coordinate with the level of activities in the
countries' national plans'; and
``(F) should be removed by Congress and replaced
with more appropriate mechanisms that--
``(i) `ensure accountability for results from
Country Teams to the U.S. Global AIDS Coordinator
and to Congress'; and
``(ii) `ensure that spending is directly
linked to and commensurate with necessary efforts
to achieve both country and overall performance
targets for prevention, treatment, care, and
orphans and vulnerable children'.
``(40) The United States Government has endorsed the
principles of harmonization in coordinating efforts to combat
HIV/AIDS commonly referred to as the `Three Ones', which
includes--
``(A) 1 agreed HIV/AIDS action framework that
provides the basis for coordination of the work of all
partners;
``(B) 1 national HIV/AIDS coordinating authority,
with a broadbased multisectoral mandate; and
``(C) 1 agreed HIV/AIDS country-level monitoring and
evaluating system.
``(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis
and Other Related Infectious Diseases, of April 26-27, 2001
(referred to in this Act as the `Abuja Declaration'), the Heads
of State and Government of the Organization of African Unity
(OAU)--
``(A) declared that they would `place the fight
against HIV/AIDS at the forefront and as the highest
priority issue in our respective national development
plans';
``(B) committed `TO TAKE PERSONAL RESPONSIBILITY AND
PROVIDE LEADERSHIP for the activities of the National
AIDS Commissions/Councils';

[[Page 2921]]
122 STAT. 2921

``(C) resolved `to lead from the front the battle
against HIV/AIDS, Tuberculosis and Other Related
Infectious Diseases by personally ensuring that such
bodies were properly convened in mobilizing our
societies as a whole and providing focus for unified
national policymaking and programme implementation,
ensuring coordination of all sectors at all levels with
a gender perspective and respect for human rights,
particularly to ensure equal rights for people living
with HIV/AIDS'; and
``(D) pledged `to set a target of allocating at
least 15% of our annual budget to the improvement of the
health sector'.''.
SEC. 3. DEFINITIONS.

Section 3 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is amended--
(1) in paragraph (2), by striking ``Committee on
International Relations'' and inserting ``Committee on Foreign
Affairs of the House of Representatives, the Committee on
Appropriations of the Senate, and the Committee on
Appropriations'';
(2) by redesignating paragraph (6) as paragraph (12);
(3) by redesignating paragraphs (3) through (5), as
paragraphs (4) through (6), respectively;
(4) by inserting after paragraph (2) the following:
``(3) Global aids coordinator.--The term `Global AIDS
Coordinator' means the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally.''; and
(5) by inserting after paragraph (6), as redesignated, the
following:
``(7) Impact evaluation research.--The term `impact
evaluation research' means the application of research methods
and statistical analysis to measure the extent to which change
in a population-based outcome can be attributed to program
intervention instead of other environmental factors.
``(8) Operations research.--The term `operations research'
means the application of social science research methods,
statistical analysis, and other appropriate scientific methods
to judge, compare, and improve policies and program outcomes,
from the earliest stages of defining and designing programs
through their development and implementation, with the objective
of the rapid dissemination of conclusions and concrete impact on
programming.
``(9) Paraprofessional.--The term `paraprofessional' means
an individual who is trained and employed as a health agent for
the provision of basic assistance in the identification,
prevention, or treatment of illness or disability.
``(10) Partner government.--The term `partner government'
means a government with which the United States is working to
provide assistance to combat HIV/AIDS, tuberculosis, or malaria
on behalf of people living within the jurisdiction of such
government.
``(11) Program monitoring.--The term `program monitoring'
means the collection, analysis, and use of routine program data
to determine--
``(A) how well a program is carried out; and

[[Page 2922]]
122 STAT. 2922

``(B) how much the program costs.''.
SEC. 4. PURPOSE.

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

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

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

[[Page 2923]]
122 STAT. 2923

TITLE I--POLICY PLANNING AND COORDINATION

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

(a) Strategy.--Section 101(a) of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7611(a)) is amended to read as follows:
``(a) Strategy.--The [NOTE: President.]  President shall establish
a comprehensive, integrated, 5-year strategy to expand and improve
efforts to combat global HIV/AIDS. This strategy shall--
``(1) further strengthen the capability of the United States
to be an effective leader of the international campaign against
this disease and strengthen the capacities of nations
experiencing HIV/AIDS epidemics to combat this disease;
``(2) maintain sufficient flexibility and remain responsive
to--
``(A) changes in the epidemic;
``(B) challenges facing partner countries in
developing and implementing an effective national
response; and
``(C) evidence-based improvements and innovations in
the prevention, care, and treatment of HIV/AIDS;
``(3) situate United States efforts to combat HIV/AIDS,
tuberculosis, and malaria within the broader United States
global health and development agenda, establishing a roadmap to
link investments in specific disease programs to the broader
goals of strengthening health systems and infrastructure and to
integrate and coordinate HIV/AIDS, tuberculosis, or malaria
programs with other health or development programs, as
appropriate;
``(4) provide a plan to--
``(A) prevent 12,000,000 new HIV infections
worldwide;
``(B) support--
``(i) the increase in the number of
individuals with HIV/AIDS receiving antiretroviral
treatment above the goal established under section
402(a)(3) and increased pursuant to paragraphs (1)
through (3) of section 403(d); and
``(ii) additional treatment through
coordinated multilateral efforts;
``(C) support care for 12,000,000 individuals
infected with or affected by HIV/AIDS, including
5,000,000 orphans and vulnerable children affected by
HIV/AIDS, with an emphasis on promoting a comprehensive,
coordinated system of services to be integrated
throughout the continuum of care;
``(D) help partner countries in the effort to
achieve goals of 80 percent access to counseling,
testing, and treatment to prevent the transmission of
HIV from mother to child, emphasizing a continuum of
care model;
``(E) help partner countries to provide care and
treatment services to children with HIV in proportion to
their percentage within the HIV-infected population in
each country;
``(F) promote preservice training for health
professionals designed to strengthen the capacity of
institutions

[[Page 2924]]
122 STAT. 2924

to develop and implement policies for training health
workers to combat HIV/AIDS, tuberculosis, and malaria;
``(G) equip teachers with skills needed for HIV/AIDS
prevention and support for persons with, or affected by,
HIV/AIDS;
``(H) provide and share best practices for combating
HIV/AIDS with health professionals;
``(I) promote pediatric HIV/AIDS training for
physicians, nurses, and other health care workers,
through public-private partnerships if possible,
including through the designation, if appropriate, of
centers of excellence for training in pediatric HIV/AIDS
prevention, care, and treatment in partner countries;
and
``(J) help partner countries to train and support
retention of health care professionals and
paraprofessionals, with the target of training and
retaining at least 140,000 new health care professionals
and paraprofessionals with an emphasis on training and
in country deployment of critically needed doctors and
nurses and to strengthen capacities in developing
countries, especially in sub-Saharan Africa, to deliver
primary health care with the objective of helping
countries achieve staffing levels of at least 2.3
doctors, nurses, and midwives per 1,000 population, as
called for by the World Health Organization;
``(5) include multisectoral approaches and specific
strategies to treat individuals infected with HIV/AIDS and to
prevent the further transmission of HIV infections, with a
particular focus on the needs of families with children
(including the prevention of mother-to-child transmission),
women, young people, orphans, and vulnerable children;
``(6) establish a timetable with annual global treatment
targets with country-level benchmarks for antiretroviral
treatment;
``(7) expand the integration of timely and relevant research
within the prevention, care, and treatment of HIV/AIDS;
``(8) include a plan for program monitoring, operations
research, and impact evaluation and for the dissemination of a
best practices report to highlight findings;
``(9) support the in-country or intra-regional training,
preferably through public-private partnerships, of scientific
investigators, managers, and other staff who are capable of
promoting the systematic uptake of clinical research findings
and other evidence-based interventions into routine practice,
with the goal of improving the quality, effectiveness, and local
leadership of HIV/AIDS health care;
``(10) expand and accelerate research on and development of
HIV/AIDS prevention methods for women, including enhancing
inter-agency collaboration, staffing, and organizational
infrastructure dedicated to microbicide research;
``(11) provide for consultation with local leaders and
officials to develop prevention strategies and programs that are
tailored to the unique needs of each country and community and
targeted particularly toward those most at risk of acquiring HIV
infection;
``(12) make the reduction of HIV/AIDS behavioral risks a
priority of all prevention efforts by--

[[Page 2925]]
122 STAT. 2925

``(A) promoting abstinence from sexual activity and
encouraging monogamy and faithfulness;
``(B) encouraging the correct and consistent use of
male and female condoms and increasing the availability
of, and access to, these commodities;
``(C) promoting the delay of sexual debut and the
reduction of multiple concurrent sexual partners;
``(D) promoting education for discordant couples
(where an individual is infected with HIV and the other
individual is uninfected or whose status is unknown)
about safer sex practices;
``(E) promoting voluntary counseling and testing,
addiction therapy, and other prevention and treatment
tools for illicit injection drug users and other
substance abusers;
``(F) educating men and boys about the risks of
procuring sex commercially and about the need to end
violent behavior toward women and girls;
``(G) supporting partner country and community
efforts to identify and address social, economic, or
cultural factors, such as migration, urbanization,
conflict, gender-based violence, lack of empowerment for
women, and transportation patterns, which directly
contribute to the transmission of HIV;
``(H) supporting comprehensive programs to promote
alternative livelihoods, safety, and social
reintegration strategies for commercial sex workers and
their families;
``(I) promoting cooperation with law enforcement to
prosecute offenders of trafficking, rape, and sexual
assault crimes with the goal of eliminating such crimes;
and
``(J) working to eliminate rape, gender-based
violence, sexual assault, and the sexual exploitation of
women and children;
``(13) include programs to reduce the transmission of HIV,
particularly addressing the heightened vulnerabilities of women
and girls to HIV in many countries; and
``(14) support other important means of preventing or
reducing the transmission of HIV, including--
``(A) medical male circumcision;
``(B) the maintenance of a safe blood supply;
``(C) promoting universal precautions in formal and
informal health care settings;
``(D) educating the public to recognize and to avoid
risks to contract HIV through blood exposures during
formal and informal health care and cosmetic services;
``(E) investigating suspected nosocomial infections
to identify and stop further nosocomial transmission;
and
``(F) other mechanisms to reduce the transmission of
HIV;
``(15) increase support for prevention of mother-to-child
transmission;
``(16) build capacity within the public health sector of
developing countries by improving health systems and public
health infrastructure and developing indicators to measure
changes in broader public health sector capabilities;
``(17) increase the coordination of HIV/AIDS programs with
development programs;

[[Page 2926]]
122 STAT. 2926

``(18) provide a framework for expanding or developing
existing or new country or regional programs, including--
``(A) drafting compacts or other agreements, as
appropriate;
``(B) establishing criteria and objectives for such
compacts and agreements; and
``(C) promoting sustainability;
``(19) provide a plan for national and regional priorities
for resource distribution and a global investment plan by
region;
``(20) provide a plan to address the immediate and ongoing
needs of women and girls, which--
``(A) addresses the vulnerabilities that contribute
to their elevated risk of infection;
``(B) includes specific goals and targets to address
these factors;
``(C) provides clear guidance to field missions to
integrate gender across prevention, care, and treatment
programs;
``(D) sets forth gender-specific indicators to
monitor progress on outcomes and impacts of gender
programs;
``(E) supports efforts in countries in which women
or orphans lack inheritance rights and other fundamental
protections to promote the passage, implementation, and
enforcement of such laws;
``(F) supports life skills training, especially
among women and girls, with the goal of reducing
vulnerabilities to HIV/AIDS;
``(G) addresses and prevents gender-based violence;
and
``(H) addresses the posttraumatic and psychosocial
consequences and provides postexposure prophylaxis
protecting against HIV infection to victims of gender-
based violence and rape;
``(21) provide a plan to--
``(A) determine the local factors that may put men
and boys at elevated risk of contracting or transmitting
HIV;
``(B) address male norms and behaviors to reduce
these risks, including by reducing alcohol abuse;
``(C) promote responsible male behavior; and
``(D) promote male participation and leadership at
the community level in efforts to promote HIV
prevention, reduce stigma, promote participation in
voluntary counseling and testing, and provide care,
treatment, and support for persons with HIV/AIDS;
``(22) provide a plan to address the vulnerabilities and
needs of orphans and children who are vulnerable to, or affected
by, HIV/AIDS;
``(23) encourage partner countries to develop health care
curricula and promote access to training tailored to individuals
receiving services through, or exiting from, existing programs
geared to orphans and vulnerable children;
``(24) provide a framework to work with international actors
and partner countries toward universal access to HIV/AIDS
prevention, treatment, and care programs, recognizing that
prevention is of particular importance;

[[Page 2927]]
122 STAT. 2927

``(25) enhance the coordination of United States bilateral
efforts to combat global HIV/AIDS with other major public and
private entities;
``(26) enhance the attention given to the national strategic
HIV/AIDS plans of countries receiving United States assistance
by--
``(A) reviewing the planning and programmatic
decisions associated with that assistance; and
``(B) helping to strengthen such national
strategies, if necessary;
``(27) support activities described in the Global Plan to
Stop TB, including--
``(A) expanding and enhancing the coverage of the
Directly Observed Treatment Short-course (DOTS) in order
to treat individuals infected with tuberculosis and HIV,
including multi-drug resistant or extensively drug
resistant tuberculosis; and
``(B) improving coordination and integration of HIV/
AIDS and tuberculosis programming;
``(28) ensure coordination between the Global AIDS
Coordinator and the Malaria Coordinator and address issues of
comorbidity between HIV/AIDS and malaria; and
``(29) include a longer term estimate of the projected
resource needs, progress toward greater sustainability and
country ownership of HIV/AIDS programs, and the anticipated role
of the United States in the global effort to combat HIV/AIDS
during the 10-year period beginning on October 1, 2013.''.

(b) Report.--Section 101(b) of such Act (22 U.S.C. 7611(b)) is
amended to read as follows:
``(b) Report.--
``(1) In general.--Not [NOTE: President.]  later than
October 1, 2009, the President shall submit a report to the
appropriate congressional committees that sets forth the
strategy described in subsection (a).
``(2) Contents.--The report required under paragraph (1)
shall include a discussion of the following elements:
``(A) The purpose, scope, methodology, and general
and specific objectives of the strategy.
``(B) The problems, risks, and threats to the
successful pursuit of the strategy.
``(C) The desired goals, objectives, activities, and
outcome-related performance measures of the strategy.
``(D) A description of future costs and resources
needed to carry out the strategy.
``(E) A delineation of United States Government
roles, responsibility, and coordination mechanisms of
the strategy.
``(F) A description of the strategy--
``(i) to promote harmonization of United
States assistance with that of other
international, national, and private actors as
elucidated in the `Three Ones'; and
``(ii) to address existing challenges in
harmonization and alignment.
``(G) A description of the manner in which the
strategy will--

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122 STAT. 2928

``(i) further the development and
implementation of the national multisectoral
strategic HIV/AIDS frameworks of partner
governments; and
``(ii) enhance the centrality, effectiveness,
and sustainability of those national plans.
``(H) A description of how the strategy will seek to
achieve the specific targets described in subsection (a)
and other targets, as appropriate.
``(I) A description of, and rationale for, the
timetable for annual global treatment targets with
country-level estimates of numbers of persons in need of
antiretroviral treatment, country-level benchmarks for
United States support for assistance for antiretroviral
treatment, and numbers of persons enrolled in
antiretroviral treatment programs receiving United
States support. If global benchmarks are not achieved
within the reporting period, the report shall include a
description of steps being taken to ensure that global
benchmarks will be achieved and a detailed breakdown and
justification of spending priorities in countries in
which benchmarks are not being met, including a
description of other donor or national support for
antiretroviral treatment in the country, if appropriate.
``(J) A description of how operations research is
addressed in the strategy and how such research can most
effectively be integrated into care, treatment, and
prevention activities in order to--
``(i) improve program quality and efficiency;
``(ii) ascertain cost effectiveness;
``(iii) ensure transparency and
accountability;
``(iv) assess population-based impact;
``(v) disseminate findings and best practices;
and
``(vi) optimize delivery of services.
``(K) An analysis of United States-assisted
strategies to prevent the transmission of HIV/AIDS,
including methodologies to promote abstinence, monogamy,
faithfulness, the correct and consistent use of male and
female condoms, reductions in concurrent sexual
partners, and delay of sexual debut, and of intended
monitoring and evaluation approaches to measure the
effectiveness of prevention programs and ensure that
they are targeted to appropriate audiences.
``(L) Within the analysis required under
subparagraph (K), an examination of additional planned
means of preventing the transmission of HIV including
medical male circumcision, maintenance of a safe blood
supply, public education about risks to acquire HIV
infection from blood exposures, promotion of universal
precautions, investigation of suspected nosocomial
infections and other tools.
``(M) A description of efforts to assist partner
country and community to identify and address social,
economic, or cultural factors, such as migration,
urbanization, conflict, gender-based violence, lack of
empowerment for women, and transportation patterns,
which directly contribute to the transmission of HIV.
``(N) A description of the specific targets, goals,
and strategies developed to address the needs and

[[Page 2929]]
122 STAT. 2929

vulnerabilities of women and girls to HIV/AIDS,
including--
``(i) activities directed toward men and boys;
``(ii) activities to enhance educational,
microfinance, and livelihood opportunities for
women and girls;
``(iii) activities to promote and protect the
legal empowerment of women, girls, and orphans and
vulnerable children;
``(iv) programs targeted toward gender-based
violence and sexual coercion;
``(v) strategies to meet the particular needs
of adolescents;
``(vi) assistance for victims of rape, sexual
abuse, assault, exploitation, and trafficking; and
``(vii) programs to prevent alcohol abuse.
``(O) A description of strategies to address male
norms and behaviors that contribute to the transmission
of HIV, to promote responsible male behavior, and to
promote male participation and leadership in HIV/AIDS
prevention, care, treatment, and voluntary counseling
and testing.
``(P) A description of strategies--
``(i) to address the needs of orphans and
vulnerable children, including an analysis of--
``(I) factors contributing to
children's vulnerability to HIV/AIDS;
and
``(II) vulnerabilities caused by the
impact of HIV/AIDS on children and their
families; and
``(ii) in areas of higher HIV/AIDS prevalence,
to promote a community-based approach to
vulnerability, maximizing community input into
determining which children participate.
``(Q) A description of capacity-building efforts
undertaken by countries themselves, including adherents
of the Abuja Declaration and an assessment of the impact
of International Monetary Fund macroeconomic and fiscal
policies on national and donor investments in health.
``(R) A description of the strategy to--
``(i) strengthen capacity building within the
public health sector;
``(ii) improve health care in those countries;
``(iii) help countries to develop and
implement national health workforce strategies;
``(iv) strive to achieve goals in training,
retaining, and effectively deploying health staff;
``(v) promote the use of codes of conduct for
ethical recruiting practices for health care
workers; and
``(vi) increase the sustainability of health
programs.
``(S) A description of the criteria for selection,
objectives, methodology, and structure of compacts or
other framework agreements with countries or regional
organizations, including--
``(i) the role of civil society;
``(ii) the degree of transparency;
``(iii) benchmarks for success of such
compacts or agreements; and

[[Page 2930]]
122 STAT. 2930

``(iv) the relationship between such compacts
or agreements and the national HIV/AIDS and public
health strategies and commitments of partner
countries.
``(T) A strategy to better coordinate HIV/AIDS
assistance with nutrition and food assistance programs.
``(U) A description of transnational or regional
initiatives to combat regionalized epidemics in highly
affected areas such as the Caribbean.
``(V) A description of planned resource distribution
and global investment by region.
``(W) A description of coordination efforts in order
to better implement the Stop TB Strategy and to address
the problem of coinfection of HIV/AIDS and tuberculosis
and of projected challenges or barriers to successful
implementation.
``(X) A description of coordination efforts to
address malaria and comorbidity with malaria and HIV/
AIDS.''.

(c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) is
amended to read as follows:
``(c) Study of Progress Toward Achievement of Policy Objectives.--
``(1) [NOTE: Contracts. Deadline.]  Design and budget plan
for data evaluation.--The Global AIDS Coordinator shall enter
into a contract with the Institute of Medicine of the National
Academies that provides that not later than 18 months after the
date of the enactment of the Tom Lantos and Henry J. Hyde United
States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act of 2008, the Institute, in
consultation with the Global AIDS Coordinator and other relevant
parties representing the public and private sector, shall
provide the Global AIDS Coordinator with a design plan and
budget for the evaluation and collection of baseline and
subsequent data to address the elements set forth in paragraph
(2)(B). The Global AIDS Coordinator shall submit the budget and
design plan to the appropriate congressional committees.
``(2) Study.--
``(A) In general.--
Not [NOTE: Deadline. Publication.]  later than 4 years
after the date of the enactment of the Tom Lantos and
Henry J. Hyde United States Global Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act
of 2008, the Institute of Medicine of the National
Academies shall publish a study that includes--
``(i) an assessment of the performance of
United States-assisted global HIV/AIDS programs;
and
``(ii) an evaluation of the impact on health
of prevention, treatment, and care efforts that
are supported by United States funding, including
multilateral and bilateral programs involving
joint operations.
``(B) Content.--The study conducted under this
paragraph shall include--
``(i) an assessment of progress toward
prevention, treatment, and care targets;
``(ii) an assessment of the effects on health
systems, including on the financing and management
of health systems and the quality of service
delivery and staffing;

[[Page 2931]]
122 STAT. 2931

``(iii) an assessment of efforts to address
gender-specific aspects of HIV/AIDS, including
gender related constraints to accessing services
and addressing underlying social and economic
vulnerabilities of women and men;
``(iv) an evaluation of the impact of
treatment and care programs on 5-year survival
rates, drug adherence, and the emergence of drug
resistance;
``(v) an evaluation of the impact of
prevention programs on HIV incidence in relevant
population groups;
``(vi) an evaluation of the impact on child
health and welfare of interventions authorized
under this Act on behalf of orphans and vulnerable
children;
``(vii) an evaluation of the impact of
programs and activities authorized in this Act on
child mortality; and
``(viii) recommendations for improving the
programs referred to in subparagraph (A)(i).
``(C) Methodologies.--Assessments and impact
evaluations conducted under the study shall utilize
sound statistical methods and techniques for the
behavioral sciences, including random assignment
methodologies as feasible. Qualitative data on process
variables should be used for assessments and impact
evaluations, wherever possible.
``(3) Contract authority.--The Institute of Medicine may
enter into contracts or cooperative agreements or award grants
to conduct the study under paragraph (2).
``(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
the study under this subsection.''.

(d) Report.--Section 101 of such Act, as amended by this section, is
further amended by adding at the end the following:
``(d) Comptroller General Report.--
``(1) Report required.--Not later than 3 years after the
date of the enactment of the Tom Lantos and Henry J. Hyde United
States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act of 2008, the Comptroller General of
the United States shall submit a report on the global HIV/AIDS
programs of the United States to the appropriate congressional
committees.
``(2) Contents.--The report required under paragraph (1)
shall include--
``(A) a description and assessment of the monitoring
and evaluation practices and policies in place for these
programs;
``(B) an assessment of coordination within Federal
agencies involved in these programs, examining both
internal coordination within these programs and
integration with the larger global health and
development agenda of the United States;
``(C) an assessment of procurement policies and
practices within these programs;
``(D) an assessment of harmonization with national
government HIV/AIDS and public health strategies as well
as other international efforts;

[[Page 2932]]
122 STAT. 2932

``(E) an assessment of the impact of global HIV/AIDS
funding and programs on other United States global
health programming; and
``(F) recommendations for improving the global HIV/
AIDS programs of the United States.

``(e) Best Practices Report.--
``(1) In general.--Not [NOTE: Publication.]  later than 1
year after the date of the enactment of the Tom Lantos and Henry
J. Hyde United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act of 2008, and
annually thereafter, the Global AIDS Coordinator shall publish a
best practices report that highlights the programs receiving
financial assistance from the United States that have the
potential for replication or adaption, particularly at a low
cost, across global AIDS programs, including those that focus on
both generalized and localized epidemics.
``(2) Dissemination of findings.--
``(A) Publication on internet website.--The Global
AIDS Coordinator shall disseminate the full findings of
the annual best practices report on the Internet website
of the Office of the Global AIDS Coordinator.
``(B) Dissemination guidance.--The Global AIDS
Coordinator shall develop guidance to ensure timely
submission and dissemination of significant information
regarding best practices with respect to global AIDS
programs.

``(f) Inspectors General.--
``(1) Oversight plan.--
``(A) Development.--The Inspectors General of the
Department of State and Broadcasting Board of Governors,
the Department of Health and Human Services, and the
United States Agency for International Development shall
jointly develop 5 coordinated annual plans for oversight
activity in each of the fiscal years 2009 through 2013,
with regard to the programs authorized under this Act
and sections 104A, 104B, and 104C of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2, 2151b-3, and
2151b-4).
``(B) Contents.--The plans developed under
subparagraph (A) shall include a schedule for financial
audits, inspections, and performance reviews, as
appropriate.
``(C) Deadline.--
``(i) Initial plan.--The first plan developed
under subparagraph (A) shall be completed not
later than the later of--
``(I) September 1, 2008; or
``(II) 60 days after the date of the
enactment of the Tom Lantos and Henry J.
Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act of 2008.
``(ii) Subsequent plans.--Each of the last
four plans developed under subparagraph (A) shall
be completed not later than 30 days before each of
the fiscal years 2010 through 2013, respectively.

[[Page 2933]]
122 STAT. 2933

``(2) Coordination.--In order to avoid duplication and
maximize efficiency, the Inspectors General described in
paragraph (1) shall coordinate their activities with--
``(A) the Government Accountability Office; and
``(B) the Inspectors General of the Department of
Commerce, the Department of Defense, the Department of
Labor, and the Peace Corps, as appropriate, pursuant to
the 2004 Memorandum of Agreement Coordinating Audit
Coverage of Programs and Activities Implementing the
President's Emergency Plan for AIDS Relief, or any
successor agreement.
``(3) Funding.--The [NOTE: Effective date.]  Global AIDS
Coordinator and the Coordinator of the United States Government
Activities to Combat Malaria Globally shall make available
necessary funds not exceeding $15,000,000 during the 5-year
period beginning on October 1, 2008 to the Inspectors General
described in paragraph (1) for the audits, inspections, and
reviews described in that paragraph.''.

(e) Annual Study; Message.--Section 101 of such Act, as amended by
this section, is further amended by adding at the end the following:
``(g) [NOTE: Deadlines.]  Annual Study.--
``(1) In general.--Not later than September 30, 2009, and
annually thereafter through September 30, 2013, the Global AIDS
Coordinator shall complete a study of treatment providers that--
``(A) represents a range of countries and service
environments;
``(B) estimates the per-patient cost of
antiretroviral HIV/AIDS treatment and the care of people
with HIV/AIDS not receiving antiretroviral treatment,
including a comparison of the costs for equivalent
services provided by programs not receiving assistance
under this Act;
``(C) estimates per-patient costs across the program
and in specific categories of service providers,
including--
``(i) urban and rural providers;
``(ii) country-specific providers; and
``(iii) other subcategories, as appropriate.
``(2) Publication.--Not [NOTE: Web site.]  later than 90
days after the completion of each study under paragraph (1), the
Global AIDS Coordinator shall make the results of such study
available on a publicly accessible Web site.

``(h) Message.--The Global AIDS Coordinator shall develop a message,
to be prominently displayed by each program receiving funds under this
Act, that--
``(1) demonstrates that the program is a commitment by
citizens of the United States to the global fight against HIV/
AIDS, tuberculosis, and malaria; and
``(2) enhances awareness by program recipients that the
program is an effort on behalf of the citizens of the United
States.''.
SEC. 102. INTERAGENCY WORKING GROUP.

Section 1(f)(2) of the State Department Basic Authorities Act of
1956 (22 U.S.C. 2651a(f)(2)) is amended--

[[Page 2934]]
122 STAT. 2934

(1) in subparagraph (A), by inserting ``, partner country
finance, health, and other relevant ministries,'' after
``community based organizations)'' each place it appears;
(2) in subparagraph (B)(ii)--
(A) by striking subclauses (IV) and (V);
(B) [NOTE: Government
organization. Establishment.]  by inserting after
subclause (III) the following:
``(IV) Establishing an interagency
working group on HIV/AIDS headed by the
Global AIDS Coordinator and comprised of
representatives from the United States
Agency for International Development and
the Department of Health and Human
Services, for the purposes of
coordination of activities relating to
HIV/AIDS, including--
``(aa) meeting regularly to
review progress in partner
countries toward HIV/AIDS
prevention, treatment, and care
objectives;
``(bb) participating in the
process of identifying countries
to consider for increased
assistance based on the
epidemiology of HIV/AIDS in
those countries, including clear
evidence of a public health
threat, as well as government
commitment to address the HIV/
AIDS problem, relative need, and
coordination and joint planning
with other significant actors;
``(cc) assisting the
Coordinator in the evaluation,
execution, and oversight of
country operational plans;
``(dd) reviewing policies
that may be obstacles to
reaching targets set forth for
HIV/AIDS prevention, treatment,
and care; and
``(ee) consulting with
representatives from additional
relevant agencies, including the
National Institutes of Health,
the Health Resources and
Services Administration, the
Department of Labor, the
Department of Agriculture, the
Millennium Challenge
Corporation, the Peace Corps,
and the Department of Defense.
``(V) Coordinating overall United
States HIV/AIDS policy and programs,
including ensuring the coordination of
relevant executive branch agency
activities in the field, with efforts
led by partner countries, and with the
assistance provided by other relevant
bilateral and multilateral aid agencies
and other donor institutions to promote
harmonization with other programs aimed
at preventing and treating HIV/AIDS and
other health challenges, improving
primary health, addressing food
security, promoting education and
development, and strengthening health
care systems.'';
(C) by redesignating subclauses (VII) and VIII) as
subclauses (IX) and (XII), respectively;
(D) by inserting after subclause (VI) the following:
``(VII) Holding annual consultations
with nongovernmental organizations in
partner countries that provide services
to improve health, and advocating on
behalf of the individuals with HIV/AIDS

[[Page 2935]]
122 STAT. 2935

and those at particular risk of
contracting HIV/AIDS, including
organizations with members who are
living with HIV/AIDS.
``(VIII) Ensuring, through
interagency and international
coordination, that HIV/AIDS programs of
the United States are coordinated with,
and complementary to, the delivery of
related global health, food security,
development, and education.'';
(E) in subclause (IX), as redesignated by
subparagraph (C)--
(i) by inserting ``Vietnam,'' after
``Uganda,'';
(ii) by inserting after ``of 2003'' the
following: ``and other countries in which the
United States is implementing HIV/AIDS programs as
part of its foreign assistance program''; and
(iii) by adding at the end the following: ``In
designating additional countries under this
subparagraph, the President shall give priority to
those countries in which there is a high
prevalence of HIV or risk of significantly
increasing incidence of HIV within the general
population and inadequate financial means within
the country.'';
(F) by inserting after subclause (IX), as
redesignated by subparagraph (C), the following:
``(X) Working with partner countries
in which the HIV/AIDS epidemic is
prevalent among injection drug users to
establish, as a national priority,
national HIV/AIDS prevention programs.
``(XI) Working with partner
countries in which the HIV/AIDS epidemic
is prevalent among individuals involved
in commercial sex acts to establish, as
a national priority, national prevention
programs, including education, voluntary
testing, and counseling, and referral
systems that link HIV/AIDS programs with
programs to eradicate trafficking in
persons and support alternatives to
prostitution.'';
(G) in subclause (XII), as redesignated by
subparagraph (C), by striking ``funds section'' and
inserting ``funds appropriated for HIV/ AIDS assistance
pursuant to the authorization of appropriations under
section 401 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7671)''; and
(H) by adding at the end the following:
``(XIII) Publicizing updated drug
pricing data to inform the purchasing
decisions of pharmaceutical procurement
partners.''.
SEC. 103. SENSE OF CONGRESS.

Section 102 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) is amended by
adding at the end the following:
``(d) Sense of Congress.--It is the sense of Congress that--
``(1) full-time country level coordinators, preferably with
management experience, should head each HIV/AIDS country

[[Page 2936]]
122 STAT. 2936

team for United States missions overseeing significant HIV/AIDS
programs;
``(2) foreign service nationals provide critically important
services in the design and implementation of United States
country-level HIV/AIDS programs and their skills and experience
as public health professionals should be recognized within
hiring and compensation practices; and
``(3) staffing levels for United States country-level HIV/
AIDS teams should be adequately maintained to fulfill oversight
and other obligations of the positions.''.

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

SEC. 201. [NOTE: Appropriations authorizations.]  VOLUNTARY
CONTRIBUTIONS TO INTERNATIONAL VACCINE
FUNDS.

Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222)
is amended--
(1) by inserting after subsection (c) the following:

``(d) Tuberculosis Vaccine Development Programs.--In addition to
amounts otherwise available under this section, there are authorized to
be appropriated to the President such sums as may be necessary for each
of the fiscal years 2009 through 2013, which shall be used for United
States contributions to tuberculosis vaccine development programs, which
may include the Aeras Global TB Vaccine Foundation.'';
(2) in subsection (k)--
(A) by striking ``fiscal years 2004 through 2008''
and inserting ``fiscal years 2009 through 2013''; and
(B) by striking ``Vaccine Fund'' and inserting
``GAVI Fund''.
(3) in subsection (l), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through 2013'';
and
(4) in subsection (m), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through 2013''.
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS,
TUBERCULOSIS AND MALARIA.

(a) Findings; Sense of Congress.--Section 202(a) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7622(a)) is amended to read as follows:
``(a) Findings; Sense of Congress.--
``(1) Findings.--Congress makes the following findings:
``(A) The establishment of the Global Fund in
January 2002 is consistent with the general principles
for an international AIDS trust fund first outlined by
Congress in the Global AIDS and Tuberculosis Relief Act
of 2000 (Public Law 106-264).
``(B) The Global Fund is an innovative financing
mechanism which--
``(i) has made progress in many areas in
combating HIV/AIDS, tuberculosis, and malaria; and

[[Page 2937]]
122 STAT. 2937

``(ii) represents the multilateral component
of this Act, extending United States efforts to
more than 130 countries around the world.
``(C) The Global Fund and United States bilateral
assistance programs--
``(i) are demonstrating increasingly effective
coordination, with each possessing certain
comparative advantages in the fight against HIV/
AIDS, tuberculosis, and malaria; and
``(ii) often work most effectively in concert
with each other.
``(D) The United States Government--
``(i) is the largest supporter of the Global
Fund in terms of resources and technical support;
``(ii) made the founding contribution to the
Global Fund; and
``(iii) is fully committed to the success of
the Global Fund as a multilateral public-private
partnership.
``(2) Sense of congress.--It is the sense of Congress that--
``(A) transparency and accountability are crucial to
the long-term success and viability of the Global Fund;
``(B) the Global Fund has made significant progress
toward addressing concerns raised by the Government
Accountability Office by--
``(i) improving risk assessment and risk
management capabilities;
``(ii) providing clearer guidance for and
oversight of Local Fund Agents; and
``(iii) strengthening the Office of the
Inspector General for the Global Fund;
``(C) the provision of sufficient resources and
authority to the Office of the Inspector General for the
Global Fund to ensure that office has the staff and
independence necessary to carry out its mandate will be
a measure of the commitment of the Global Fund to
transparency and accountability;
``(D) regular, publicly published financial,
programmatic, and reporting audits of the Fund, its
grantees, and Local Fund Agents are also important
benchmarks of transparency;
``(E) the Global Fund should establish and maintain
a system to track--
``(i) the amount of funds disbursed to each
subrecipient on the grant's fiscal cycle; and
``(ii) the distribution of resources, by grant
and principal recipient, for prevention, care,
treatment, drug and commodity purchases, and other
purposes;
``(F) relevant national authorities in recipient
countries should exempt from duties and taxes all
products financed by Global Fund grants and procured by
any principal recipient or subrecipient for the purpose
of carrying out such grants;
``(G) the Global Fund, UNAIDS, and the Global AIDS
Coordinator should work together to standardize program
indicators wherever possible;
``(H) for purposes of evaluating total amounts of
funds contributed to the Global Fund under subsection

[[Page 2938]]
122 STAT. 2938

(d)(4)(A)(i), the timetable for evaluations of
contributions from sources other than the United States
should take into account the fiscal calendars of other
major contributors; and
``(I) the Global Fund should not support activities
involving the `Affordable Medicines Facility-Malaria' or
similar entities pending compelling evidence of success
from pilot programs as evaluated by the Coordinator of
United States Government Activities to Combat Malaria
Globally.''.

(b) Statement of Policy.--Section 202(b) of such Act [NOTE: 22 USC
7622.]  is amended by adding at the end the following:
``(3) Statement of policy.--The United States Government
regards the imposition by recipient countries of taxes or
tariffs on goods or services provided by the Global Fund, which
are supported through public and private donations, including
the substantial contribution of the American people, as
inappropriate and inconsistent with standards of good
governance. [NOTE: Taxes. Tariffs.]  The Global AIDS
Coordinator or other representatives of the United States
Government shall work with the Global Fund to dissuade
governments from imposing such duties, tariffs, or taxes.''.

(c) United States Financial Participation.--Section 202(d) of such
Act (22 U.S.C. 7622(d)) is amended--
(1) in paragraph (1)--
(A) by striking ``$1,000,000,000 for the period of
fiscal year 2004 beginning on January 1, 2004'' and
inserting ``$2,000,000,000 for fiscal year 2009,''; and
(B) by striking ``the fiscal years 2005-2008'' and
inserting ``each of the fiscal years 2010 through
2013'';
(2) in paragraph (4)--
(A) in subparagraph (A)--
(i) in clause (i), by striking ``fiscal years
2004 through 2008'' and inserting ``fiscal years
2009 through 2013'';
(ii) in clause (ii)--
(I) by striking ``during any of the
fiscal years 2004 through 2008'' and
inserting ``during any of the fiscal
years 2009 through 2013''; and
(II) by adding at the end the
following: ``The President may waive the
application of this clause with respect
to assistance for Sudan that is overseen
by the Southern Country Coordinating
Mechanism, including Southern Sudan,
Southern Kordofan, Blue Nile State, and
Abyei, if the President determines that
the national interest or
humanitarian [NOTE: Federal
Register, publication. Deadline.]
reasons justify such a waiver. The
President shall publish each waiver of
this clause in the Federal Register and,
not later than 15 days before the waiver
takes effect, shall consult with the
Committee on Foreign Relations of the
Senate and the Committee on Foreign
Affairs of the House of Representatives
regarding the proposed waiver.''; and
(iii) in clause (vi)--
(I) by striking ``for the purposes''
and inserting ``For the purposes'';

[[Page 2939]]
122 STAT. 2939

(II) by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal
years 2009 through 2013''; and
(III) by striking ``prior to fiscal
year 2004'' and inserting ``before
fiscal year 2009'';
(B) in subparagraph (B)(iv), by striking ``fiscal
years 2004 through 2008'' and inserting ``fiscal years
2009 through 2013''; and
(C) in subparagraph (C)(ii), by striking ``Committee
on International Relations'' and inserting ``Committee
on Foreign Affairs''; and
(3) by adding at the end the following:
``(5) Withholding funds.--
Notwithstanding [NOTE: Certification.]  any other provision of
this Act, 20 percent of the amounts appropriated pursuant to
this Act for a contribution to support the Global Fund for each
of the fiscal years 2010 through 2013 shall be withheld from
obligation to the Global Fund until the Secretary of State
certifies to the appropriate congressional committees that the
Global Fund--
``(A) [NOTE: Performance evaluation.]  has
established an evaluation framework for the performance
of Local Fund Agents (referred to in this paragraph as
`LFAs');
``(B) is undertaking a systematic assessment of the
performance of LFAs;
``(C) [NOTE: Public information. Web site.]  has
adopted, and is implementing, a policy to publish on a
publicly available Web site--
``(i) grant performance reviews;
``(ii) all reports of the Inspector General of
the Global Fund, in a manner that is consistent
with the Policy for Disclosure of Reports of the
Inspector General, approved at the 16th Meeting of
the Board of the Global Fund;
``(iii) decision points of the Board of the
Global Fund;
``(iv) reports from Board committees to the
Board; and
``(v) a regular collection and analysis of
performance data and funding of grants of the
Global Fund, which shall cover all principal
recipients and all subrecipients;
``(D) is maintaining an independent, well-staffed
Office of the Inspector General that--
``(i) [NOTE: Reports.]  reports directly to
the Board of the Global Fund; and
``(ii) [NOTE: Public information.]  compiles
regular, publicly published audits of financial,
programmatic, and reporting aspects of the Global
Fund, its grantees, and LFAs;
``(E) [NOTE: Public
information. Reports. Public information. Reports.]
has established, and is reporting publicly on, standard
indicators for all program areas;
``(F) has established a methodology to track and is
publicly reporting on--
``(i) all subrecipients and the amount of
funds disbursed to each subrecipient on the
grant's fiscal cycle; and
``(ii) the distribution of resources, by grant
and principal recipient, for prevention, care,
treatment, drugs and commodities purchase, and
other purposes;

[[Page 2940]]
122 STAT. 2940

``(G) has established a policy on tariffs imposed by
national governments on all goods and services financed
by the Global Fund;
``(H) through its Secretariat, has taken meaningful
steps to prevent national authorities in recipient
countries from imposing taxes or tariffs on goods or
services provided by the Fund;
``(I) is maintaining its status as a financing
institution focused on programs directly related to HIV/
AIDS, malaria, and tuberculosis;
``(J) is maintaining and making progress on--
``(i) sustaining its multisectoral approach,
through country coordinating mechanisms; and
``(ii) the implementation of grants, as
reflected in the proportion of resources allocated
to different sectors, including governments, civil
society, and faith- and community-based
organizations; and
``(K) has established procedures providing access by
the Office of Inspector General of the Department of
State and Broadcasting Board of Governors, as cognizant
Inspector General, and the Inspector General of the
Health and Human Services and the Inspector General of
the United States Agency for International Development,
to Global Fund financial data, and other information
relevant to United States contributions (as determined
by the Inspector General in consultation with the Global
AIDS Coordinator).
``(6) Summaries of board decisions and united states
positions.--Following [NOTE: Reports. Public information. Web
site.]  each meeting of the Board of the Global Fund, the
Coordinator of United States Government Activities to Combat
HIV/AIDS Globally shall report on the public website of the
Coordinator a summary of Board decisions and how the United
States Government voted and its positions on such decisions.''.
SEC. 203. [NOTE: 42 USC 300cc-40a note.]  RESEARCH ON METHODS
FOR WOMEN TO PREVENT TRANSMISSION OF HIV
AND OTHER DISEASES.

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

``(a) Federal Strategic Plan.--The Director of the Office shall--
``(1) expedite the implementation of the Federal strategic
plans required by section 403(a) of the Public Health Service
Act (42 U.S.C. 283(a)(5)) regarding the conduct and support of
research on, and development of, a microbicide to prevent the
transmission of the human immunodeficiency virus; and
``(2) review and, as appropriate, revise such plan to
prioritize funding and activities relative to their scientific
urgency and potential market readiness.

[[Page 2941]]
122 STAT. 2941

``(b) Coordination.--In implementing, reviewing, and prioritizing
elements of the plan described in subsection (a), the Director of the
Office shall consult, as appropriate, with--
``(1) representatives of other Federal agencies involved in
microbicide research, including the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, the Director
of the Centers for Disease Control and Prevention, and the
Administrator of the United States Agency for International
Development;
``(2) the microbicide research and development community;
and
``(3) health advocates.''.

(c) National Institute of Allergy and Infectious Diseases.--Subpart
6 of part C of title IV of the Public Health Service Act (42 U.S.C. 285f
et seq.) is amended by adding at the end the following:
``SEC. 447C. [NOTE: Women. 42 USC 285f-4.]  MICROBICIDE RESEARCH
AND DEVELOPMENT.

``The Director of the Institute, acting through the head of the
Division of AIDS, shall, consistent with the peer-review process of the
National Institutes of Health, carry out research on, and development
of, safe and effective methods for use by women to prevent the
transmission of the human immunodeficiency virus, which may include
microbicides.''.
(d) CDC.--Part B of title III of the Public Health Service Act (42
U.S.C. 243 et seq.) is amended by inserting after section 317S the
following:
``SEC. 317T. [NOTE: 42 USC 247b-22.]  MICROBICIDE RESEARCH.

``(a) In General.--The Director of the Centers for Disease Control
and Prevention is strongly encouraged to fully implement the Centers'
microbicide agenda to support research and development of microbicides
for use to prevent the transmission of the human immunodeficiency virus.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for each of fiscal years 2009
through 2013 to carry out this section.''.
(e) [NOTE: 22 USC 7631a.]  United States Agency for International
Development.--
(1) In general.--The Administrator of the United States
Agency for International Development, in coordination with the
Coordinator of United States Government Activities to Combat
HIV/AIDS Globally, may facilitate availability and accessibility
of microbicides, provided that such pharmaceuticals are
approved, tentatively approved, or otherwise authorized for use
by--
(A) the Food and Drug Administration;
(B) a stringent regulatory agency acceptable to the
Secretary of Health and Human Services; or
(C) a quality assurance mechanism acceptable to the
Secretary of Health and Human Services.
(2) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there are
authorized to be appropriated to the President such sums as may
be necessary for each of the fiscal years 2009 through 2013 to
carry out this subsection.

[[Page 2942]]
122 STAT. 2942

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

(a) In General.--Title II of the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621) is
amended by adding at the end the following:
``SEC. 204. [NOTE: 22 USC 7623.]  COMBATING HIV/AIDS,
TUBERCULOSIS, AND MALARIA BY STRENGTHENING
HEALTH POLICIES AND HEALTH SYSTEMS OF
PARTNER COUNTRIES.

``(a) Statement of Policy.--It shall be the policy of the United
States Government--
``(1) to invest appropriate resources authorized under this
Act--
``(A) to carry out activities to strengthen HIV/
AIDS, tuberculosis, and malaria health policies and
health systems; and
``(B) to provide workforce training and capacity-
building consistent with the goals and objectives of
this Act; and
``(2) to support the development of a sound policy
environment in partner countries to increase the ability of such
countries--
``(A) to maximize utilization of health care
resources from donor countries;
``(B) to increase national investments in health and
education and maximize the effectiveness of such
investments;
``(C) to improve national HIV/AIDS, tuberculosis,
and malaria strategies;
``(D) to deliver evidence-based services in an
effective and efficient manner; and
``(E) to reduce barriers that prevent recipients of
services from achieving maximum benefit from such
services.

``(b) Assistance To Improve Public Finance Management Systems.--
``(1) In general.--Consistent with the authority under
section 129 of the Foreign Assistance Act of 1961 (22 U.S.C.
2152), the Secretary of the Treasury, acting through the head of
the Office of Technical Assistance, is authorized to provide
assistance for advisors and partner country finance, health, and
other relevant ministries to improve the effectiveness of public
finance management systems in partner countries to enable such
countries to receive funding to carry out programs to combat
HIV/AIDS, tuberculosis, and malaria and to manage such programs.
``(2) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401 for HIV/AIDS
assistance, there are authorized to be appropriated to the
Secretary of the Treasury such sums as may be necessary for each
of the fiscal years 2009 through 2013 to carry out this
subsection.

``(c) Plan Required.--The Global AIDS Coordinator, in collaboration
with the Administrator of the United States Agency for International
Development (USAID), shall develop and implement a plan to combat HIV/
AIDS by strengthening health policies and health systems of partner
countries as part of USAID's `Health

[[Page 2943]]
122 STAT. 2943

Systems 2020' project. Recognizing that human and institutional capacity
form the core of any health care system that can sustain the fight
against HIV/AIDS, tuberculosis, and malaria, the plan shall include a
strategy to encourage postsecondary educational institutions in partner
countries, particularly in Africa, in collaboration with United States
postsecondary educational institutions, including historically black
colleges and universities, to develop such human and institutional
capacity and in the process further build their capacity to sustain the
fight against these diseases.''.
(b) Clerical Amendment.--The table of contents for the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7601 note) is amended by inserting after the item relating to
section 203, as added by section 203 of this Act, the following:

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

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

Section 307 of the Public Health Service Act (42 U.S.C. 242l) is
amended--
(1) by amending subsection (a) to read as follows:

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

[[Page 2944]]
122 STAT. 2944

(B) by inserting or ``or section 903 of the Foreign
Service Act of 1980 (22 U.S.C. 4083)'' after ``Code''.
SEC. 206. [NOTE: 22 USC 7624.]  FACILITATING VACCINE
DEVELOPMENT.

(a) Technical Assistance for Developing Countries.--The
Administrator of the United States Agency for International Development,
utilizing public-private partners, as appropriate, and working in
coordination with other international development agencies, is
authorized to strengthen the capacity of developing countries'
governmental institutions to--
(1) collect evidence for informed decision-making and
introduction of new vaccines, including potential HIV/AIDS,
tuberculosis, and malaria vaccines, if such vaccines are
determined to be safe and effective;
(2) review protocols for clinical trials and impact studies
and improve the implementation of clinical trials; and
(3) ensure adequate supply chain and delivery systems.

(b) Advanced Market Commitments.--
(1) Purpose.--The purpose of this subsection is to improve
global health by requiring the United States to participate in
negotiations for advance market commitments for the development
of future vaccines, including potential vaccines for HIV/AIDS,
tuberculosis, and malaria.
(2) Negotiation requirement.--The Secretary of the Treasury
shall enter into negotiations with the appropriate officials of
the International Bank of Reconstruction and Development (World
Bank) and the GAVI Alliance, the member nations of such
entities, and other interested parties to establish advanced
market commitments to purchase vaccines to combat HIV/AIDS,
tuberculosis, malaria, and other related infectious diseases.
(3) Requirements.--In negotiating the United States
participation in programs for advanced market commitments, the
Secretary of the Treasury shall take into account whether
programs for advance market commitments include--
(A) legally binding contracts for product purchase
that include a fair market price for up to a maximum
number of treatments, creating a strong market
incentive;
(B) clearly defined and transparent rules of program
participation for qualified developers and suppliers of
the product;
(C) clearly defined requirements for eligible
vaccines to ensure that they are safe and effective and
can be delivered in developing country contexts;
(D) dispute settlement mechanisms; and
(E) sufficient flexibility to enable the contracts
to be adjusted in accord with new information related to
projected market size and other factors while still
maintaining the purchase commitment at a fair price.
(4) Report.--Not [NOTE: Deadline.]  later than 1 year
after the date of the enactment of this Act--
(A) the Secretary of the Treasury shall submit a
report to the appropriate congressional committees on
the status of the United States negotiations to
participate in programs for the advanced market
commitments under this subsection; and

[[Page 2945]]
122 STAT. 2945

(B) [NOTE: President.]  the President shall
produce a comprehensive report, written by a study group
of qualified professionals from relevant Federal
agencies and initiatives, nongovernmental organizations,
and industry representatives, that sets forth a
coordinated strategy to accelerate development of
vaccines for infectious diseases, such as HIV/AIDS,
malaria, and tuberculosis, which includes--
(i) initiatives to create economic incentives
for the research, development, and manufacturing
of vaccines for HIV/AIDS, tuberculosis, malaria,
and other infectious diseases;
(ii) an expansion of public-private
partnerships and the leveraging of resources from
other countries and the private sector; and
(iii) efforts to maximize United States
capabilities to support clinical trials of
vaccines in developing countries and to address
the challenges of delivering vaccines in
developing countries to minimize delays in access
once vaccines are available.

TITLE III--BILATERAL EFFORTS

Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

(a) Amendments to the Foreign Assistance Act of 1961.--
(1) Finding.--Section 104A(a) of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151b-2(a)) is amended by inserting ``Central
Asia, Eastern Europe, Latin America'' after ``Caribbean,''.
(2) Policy.--Section 104A(b) of such Act is amended to read
as follows:

``(b) Policy.--
``(1) Objectives.--It is a major objective of the foreign
assistance program of the United States to provide assistance
for the prevention and treatment of HIV/AIDS and the care of
those affected by the disease. It is the policy objective of the
United States, by 2013, to--
``(A) assist partner countries to--
``(i) prevent 12,000,000 new HIV infections
worldwide;
``(ii) support--
``(I) the increase in the number of
individuals with HIV/AIDS receiving
antiretroviral treatment above the goal
established under section 402(a)(3) and
increased pursuant to paragraphs (1)
through (3) of section 403(d); and
``(II) additional treatment through
coordinated multilateral efforts;
``(iii) support care for 12,000,000
individuals infected with or affected by HIV/AIDS,
including 5,000,000 orphans and vulnerable
children affected by

[[Page 2946]]
122 STAT. 2946

HIV/AIDS, with an emphasis on promoting a
comprehensive, coordinated system of services to
be integrated throughout the continuum of care;
``(iv) provide at least 80 percent of the
target population with access to counseling,
testing, and treatment to prevent the transmission
of HIV from mother-to-child;
``(v) provide care and treatment services to
children with HIV in proportion to their
percentage within the HIV-infected population of a
given partner country; and
``(vi) train and support retention of health
care professionals, paraprofessionals, and
community health workers in HIV/AIDS prevention,
treatment, and care, with the target of providing
such training to at least 140,000 new health care
professionals and paraprofessionals with an
emphasis on training and in country deployment of
critically needed doctors and nurses;
``(B) strengthen the capacity to deliver primary
health care in developing countries, especially in sub-
Saharan Africa;
``(C) support and help countries in their efforts to
achieve staffing levels of at least 2.3 doctors, nurses,
and midwives per 1,000 population, as called for by the
World Health Organization; and
``(D) help partner countries to develop independent,
sustainable HIV/AIDS programs.
``(2) Coordinated global strategy.--The United States and
other countries with the sufficient capacity should provide
assistance to countries in sub-Saharan Africa, the Caribbean,
Central Asia, Eastern Europe, and Latin America, and other
countries and regions confronting HIV/AIDS epidemics in a
coordinated global strategy to help address generalized and
concentrated epidemics through HIV/AIDS prevention, treatment,
care, monitoring and evaluation, and related activities.
``(3) Priorities.--The United States Government's response
to the global HIV/AIDS pandemic and the Government's efforts to
help countries assume leadership of sustainable campaigns to
combat their local epidemics should place high priority on--
``(A) the prevention of the transmission of HIV;
``(B) moving toward universal access to HIV/AIDS
prevention counseling and services;
``(C) the inclusion of cost sharing assurances that
meet the requirements under section 110; and
``(D) the inclusion of transition strategies to
ensure sustainability of such programs and activities,
including health care systems, under other international
donor support, or budget support by respective foreign
governments.''.

(b) Authorization.--Section 104A(c) of such Act is amended--
(1) in paragraph (1), by striking ``and other countries and
areas.'' and inserting ``Central Asia, Eastern Europe, Latin
America, and other countries and areas, particularly with
respect to refugee populations or those in postconflict settings
in such countries and areas with significant or increasing HIV
incidence rates.'';

[[Page 2947]]
122 STAT. 2947

(2) in paragraph (2), by striking ``and other countries and
areas affected by the HIV/AIDS pandemic'' and inserting
``Central Asia, Eastern Europe, Latin America, and other
countries and areas affected by the HIV/AIDS pandemic,
particularly with respect to refugee populations or those in
post-conflict settings in such countries and areas with
significant or increasing HIV incidence rates.''; and
(3) in paragraph (3)--
(A) by striking ``foreign countries'' and inserting
``partner countries, other international actors,''; and
(B) by inserting ``within the framework of the
principles of the Three Ones'' before the period at the
end.

(c) Activities Supported.--Section 104A(d) of such Act is amended--
(1) in paragraph (1)--
(A) in subparagraph (A)--
(i) by inserting ``and multiple concurrent
sexual partnering,'' after ``casual sexual
partnering''; and
(ii) by striking ``condoms'' and inserting
``male and female condoms'';
(B) in subparagraph (B)--
(i) by striking ``programs that'' and
inserting ``programs that are designed with local
input and''; and
(ii) by striking ``those organizations'' and
inserting ``those locally based organizations'';
(C) in subparagraph (D), by inserting ``and
promoting the use of provider-initiated or `opt-out'
voluntary testing in accordance with World Health
Organization guidelines'' before the semicolon at the
end;
(D) by redesignating subparagraphs (F), (G), and (H)
as subparagraphs (H), (I), and (J), respectively;
(E) by inserting after subparagraph (E) the
following:
``(F) assistance to--
``(i) achieve the goal of reaching 80 percent
of pregnant women for prevention and treatment of
mother-to-child transmission of HIV in countries
in which the United States is implementing HIV/
AIDS programs by 2013; and
``(ii) promote infant feeding options and
treatment protocols that meet the most recent
criteria established by the World Health
Organization;
``(G) medical male circumcision programs as part of
national strategies to combat the transmission of HIV/
AIDS;'';
(F) in subparagraph (I), as redesignated, by
striking ``and'' at the end; and
(G) by adding at the end the following:
``(K) assistance for counseling, testing, treatment,
care, and support programs, including--
``(i) counseling and other services for the
prevention of reinfection of individuals with HIV/
AIDS;
``(ii) counseling to prevent sexual
transmission of HIV, including--
``(I) life skills development for
practicing abstinence and faithfulness;
``(II) reducing the number of sexual
partners;
``(III) delaying sexual debut; and

[[Page 2948]]
122 STAT. 2948

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

[[Page 2949]]
122 STAT. 2949

regarding gender-responsive interventions,
disaggregated by age and sex;
``(ii) identify and replicate effective
models; and
``(iii) develop gender indicators to measure
outcomes and the impacts of interventions; and
``(F) establishing appropriate systems to--
``(i) gather epidemiological and social
science data on HIV; and
``(ii) evaluate the effectiveness of
prevention efforts among men who have sex with
men, with due consideration to stigma and risks
associated with disclosure.'';
(4) in paragraph (5)--
(A) by redesignating subparagraph (C) as
subparagraph (D); and
(B) by inserting after subparagraph (B) the
following:
``(C) Mechanism to ensure cost-effective drug
purchasing.--Subject to subparagraph (B), mechanisms to
ensure that safe and effective pharmaceuticals,
including antiretrovirals and medicines to treat
opportunistic infections, are purchased at the lowest
possible price at which such pharmaceuticals may be
obtained in sufficient quantity on the world market,
provided that such pharmaceuticals are approved,
tentatively approved, or otherwise authorized for use
by--
``(i) the Food and Drug Administration;
``(ii) a stringent regulatory agency
acceptable to the Secretary of Health and Human
Services; or
``(iii) a quality assurance mechanism
acceptable to the Secretary of Health and Human
Services.'';
(5) in paragraph (6)--
(A) by amending the paragraph heading to read as
follows:
``(6) Related and coordinated activities.--'';
(B) in subparagraph (B), by striking ``and'' at the
end;
(C) in subparagraph (C), by striking the period at
the end and inserting ``; and''; and
(D) by adding at the end the following:
``(D) coordinated or referred activities to--
``(i) enhance the clinical impact of HIV/AIDS
care and treatment; and
``(ii) ameliorate the adverse social and
economic costs often affecting AIDS-impacted
families and communities through the direct
provision, as necessary, or through the referral,
if possible, of support services, including--
``(I) nutritional and food support;
``(II) safe drinking water and
adequate sanitation;
``(III) nutritional counseling;
``(IV) income-generating activities
and livelihood initiatives;
``(V) maternal and child health
care;
``(VI) primary health care;
``(VII) the diagnosis and treatment
of other infectious or sexually
transmitted diseases;
``(VIII) substance abuse and
treatment services; and

[[Page 2950]]
122 STAT. 2950

``(IX) legal services;
``(E) coordinated or referred activities to link
programs addressing HIV/AIDS with programs addressing
gender-based violence in areas of significant HIV
prevalence to assist countries in the development and
enforcement of women's health, children's health, and
HIV/AIDS laws and policies that--
``(i) prevent and respond to violence against
women and girls;
``(ii) promote the integration of screening
and assessment for gender-based violence into HIV/
AIDS programming;
``(iii) promote appropriate HIV/AIDS
counseling, testing, and treatment into gender-
based violence programs; and
``(iv) assist governments to develop
partnerships with civil society organizations to
create networks for psychosocial, legal, economic,
or other support services;
``(F) coordinated or referred activities to--
``(i) address the frequent coinfection of HIV
and tuberculosis, in accordance with World Health
Organization guidelines;
``(ii) promote provider-initiated or `opt-out'
HIV/AIDS counseling and testing and appropriate
referral for treatment and care to individuals
with tuberculosis or its symptoms, particularly in
areas with significant HIV prevalence; and
``(iii) strengthen programs to ensure that
individuals testing positive for HIV receive
tuberculosis screening and to improve laboratory
capacities, infection control, and adherence; and
``(G) activities to--
``(i) improve the effectiveness of national
responses to HIV/AIDS;
``(ii) strengthen overall health systems in
high-prevalence countries, including support for
workforce training, retention, and effective
deployment, capacity building, laboratory
development, equipment maintenance and repair, and
public health and related public financial
management systems and operations; and
``(iii) encourage fair and transparent
procurement practices among partner countries; and
``(iv) promote in-country or intra-regional
pediatric training for physicians and other health
professionals, preferably through public-private
partnerships involving colleges and universities,
with the goal of increasing pediatric HIV
workforce capacity.''; and
(6) by adding at the end the following:
``(8) Compacts and framework agreements.--The development of
compacts or framework agreements, tailored to local
circumstances, with national governments or regional
partnerships in countries with significant HIV/AIDS burdens to
promote host government commitment to deeper integration of HIV/
AIDS services into health systems, contribute to health systems
overall, and enhance sustainability, including--
``(A) cost sharing assurances that meet the
requirements under section 110; and

[[Page 2951]]
122 STAT. 2951

``(B) transition strategies to ensure sustainability
of such programs and activities, including health care
systems, under other international donor support, or
budget support by respective foreign governments.''.

(d) Compacts and Framework Agreements.--Section 104A of such Act is
amended--
(1) by redesignating subsections (e) through (g) as
subsections (f) through (h); and
(2) by inserting after subsection (d) the following:

``(e) Compacts and Framework Agreements.--
``(1) Findings.--Congress makes the following findings:
``(A) The congressionally mandated Institute of
Medicine report entitled `PEPFAR Implementation:
Progress and Promise' states: `The next strategy [of the
U.S. Global AIDS Initiative] should squarely address the
needs and challenges involved in supporting sustainable
country HIV/AIDS programs, thereby transitioning from a
focus on emergency relief.'.
``(B) One mechanism to promote the transition from
an emergency to a public health and development approach
to HIV/AIDS is through compacts or framework agreements
between the United States Government and each
participating nation.
``(2) Elements.--Compacts on HIV/AIDS authorized under
subsection (d)(8) shall include the following elements:
``(A) Compacts whose primary purpose is to provide
direct services to combat HIV/AIDS are to be made
between--
``(i) the United States Government; and
``(ii)(I) national or regional entities
representing low-income countries served by an
existing United States Agency for International
Development or Department of Health and Human
Services presence or regional platform; or
``(II) countries or regions--
``(aa) experiencing significantly
high HIV prevalence or risk of
significantly increasing incidence
within the general population;
``(bb) served by an existing United
States Agency for International
Development or Department of Health and
Human Services presence or regional
platform; and
``(cc) that have inadequate
financial means within such country or
region.
``(B) Compacts whose primary purpose is to provide
limited technical assistance to a country or region
connected to services provided within the country or
region--
``(i) may be made with other countries or
regional entities served by an existing United
States Agency for International Development or
Department of Health and Human Services presence
or regional platform;
``(ii) shall require significant investments
in HIV prevention, care, and treatment services by
the host country;
``(iii) [NOTE: Deadlines.]  shall be time-
limited in terms of United States contributions;
and

[[Page 2952]]
122 STAT. 2952

``(iv) [NOTE: Notification.]  shall be made
only upon prior notification to Congress--
``(I) justifying the need for such
compacts;
``(II) describing the expected
investment by the country or regional
entity; and
``(III) describing the scope,
nature, expected total United States
investment, and time frame of the
limited technical assistance under the
compact and its intended impact.
``(C) Compacts shall include provisions to--
``(i) promote local and national efforts to
reduce stigma associated with HIV/AIDS; and
``(ii) work with and promote the role of civil
society in combating HIV/AIDS.
``(D) Compacts shall take into account the overall
national health and development and national HIV/AIDS
and public health strategies of each country.
``(E) Compacts shall contain--
``(i) consideration of the specific objectives
that the country and the United States expect to
achieve during the term of a compact;
``(ii) consideration of the respective
responsibilities of the country and the United
States in the achievement of such objectives;
``(iii) consideration of regular benchmarks to
measure progress toward achieving such objectives;
``(iv) an identification of the intended
beneficiaries, disaggregated by gender and age,
and including information on orphans and
vulnerable children, to the maximum extent
practicable;
``(v) consideration of the methods by which
the compact is intended to--
``(I) address the factors that put
women and girls at greater risk of HIV/
AIDS; and
``(II) strengthen elements such as
the economic, educational, and social
status of women, girls, orphans, and
vulnerable children and the inheritance
rights and safety of such individuals;
``(vi) consideration of the methods by which
the compact will--
``(I) strengthen the health care
capacity, including factors such as the
training, retention, deployment,
recruitment, and utilization of health
care workers;
``(II) improve supply chain
management; and
``(III) improve the health systems
and infrastructure of the partner
country, including the ability of
compact participants to maintain and
operate equipment transferred or
purchased as part of the compact;
``(vii) consideration of proposed mechanisms
to provide oversight;
``(viii) consideration of the role of civil
society in the development of a compact and the
achievement of its objectives;

[[Page 2953]]
122 STAT. 2953

``(ix) a description of the current and
potential participation of other donors in the
achievement of such objectives, as appropriate;
and
``(x) consideration of a plan to ensure
appropriate fiscal accountability for the use of
assistance.
``(F) For regional compacts, priority shall be given
to countries that are included in regional funds and
programs in existence as of the date of the enactment of
the Tom Lantos and Henry J. Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008.
``(G) Amounts made available for compacts described
in subparagraphs (A) and (B) shall be subject to the
inclusion of--
``(i) cost sharing assurances that meet the
requirements under section 110; and
``(ii) transition strategies to ensure
sustainability of such programs and activities,
including health care systems, under other
international donor support, and budget support by
respective foreign governments.
``(3) Local input.--In entering into a compact on HIV/AIDS
authorized under subsection (d)(8), the Coordinator of United
States Government Activities to Combat HIV/AIDS Globally shall
seek to ensure that the government of a country--
``(A) takes into account the local perspectives of
the rural and urban poor, including women, in each
country; and
``(B) consults with private and voluntary
organizations, including faith-based organizations, the
business community, and other donors in the country.
``(4) Congressional and public notification after entering
into a compact.--Not [NOTE: Deadline. Reports.]  later than 10
days after entering into a compact authorized under subsection
(d)(8), the Global AIDS Coordinator shall--
``(A) submit a report containing a detailed summary
of the compact and a copy of the text of the compact
to--
``(i) the Committee on Foreign Relations of
the Senate;
``(ii) the Committee on Appropriations of the
Senate;
``(iii) the Committee on Foreign Affairs of
the House of Representatives; and
``(iv) the Committee on Appropriations of the
House of Representatives; and
``(B) [NOTE: Federal Register, publication. Web
site.]  publish such information in the Federal
Register and on the Internet website of the Office of
the Global AIDS Coordinator.''.

(e) Annual Report.--Section 104A(f) of such Act, as redesignated, is
amended--
(1) in paragraph (1), by striking ``Committee on
International Relations'' and inserting ``Committee on Foreign
Affairs''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the
end;

[[Page 2954]]
122 STAT. 2954

(B) by striking subparagraph (C) and inserting the
following:
``(C) a detailed breakdown of funding allocations,
by program and by country, for prevention activities;
and
``(D) a detailed assessment of the impact of
programs established pursuant to such sections,
including--
``(i)(I) the effectiveness of such programs in
reducing--
``(aa) the transmission of HIV,
particularly in women and girls;
``(bb) mother-to-child transmission
of HIV, including through drug treatment
and therapies, either directly or by
referral; and
``(cc) mortality rates from HIV/
AIDS;
``(II) the number of patients receiving
treatment for AIDS in each country that receives
assistance under this Act;
``(III) an assessment of progress towards the
achievement of annual goals set forth in the
timetable required under the 5-year strategy
established under section 101 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 and, if annual goals are not
being met, the reasons for such failure; and
``(IV) retention and attrition data for
programs receiving United States assistance,
including mortality and loss to follow-up rates,
organized overall and by country;
``(ii) the progress made toward--
``(I) improving health care delivery
systems (including the training of
health care workers, including doctors,
nurses, midwives, pharmacists,
laboratory technicians, and compensated
community health workers, and the use of
codes of conduct for ethical recruiting
practices for health care workers);
``(II) advancing safe working
conditions for health care workers; and
``(III) improving infrastructure to
promote progress toward universal access
to HIV/AIDS prevention, treatment, and
care by 2013;
``(iii) a description of coordination efforts
with relevant executive branch agencies to link
HIV/AIDS clinical and social services with non-
HIV/AIDS services as part of the United States
health and development agenda;
``(iv) a detailed description of integrated
HIV/AIDS and food and nutrition programs and
services, including--
``(I) the amount spent on food and
nutrition support;
``(II) the types of activities
supported; and
``(III) an assessment of the
effectiveness of interventions carried
out to improve the health status of
persons with HIV/AIDS receiving food or
nutritional support;

[[Page 2955]]
122 STAT. 2955

``(v) a description of efforts to improve
harmonization, in terms of relevant executive
branch agencies, coordination with other public
and private entities, and coordination with
partner countries' national strategic plans as
called for in the `Three Ones';
``(vi) a description of--
``(I) the efforts of partner
countries that were signatories to the
Abuja Declaration on HIV/AIDS,
Tuberculosis and Other Related
Infectious Diseases to adhere to the
goals of such Declaration in terms of
investments in public health, including
HIV/AIDS; and
``(II) a description of the HIV/AIDS
investments of partner countries that
were not signatories to such
Declaration;
``(vii) a detailed description of any compacts
or framework agreements reached or negotiated
between the United States and any partner
countries, including a description of the elements
of compacts described in subsection (e);
``(viii) a description of programs serving
women and girls, including--
``(I) HIV/AIDS prevention programs
that address the vulnerabilities of
girls and women to HIV/AIDS;
``(II) information on the number of
individuals served by programs aimed at
reducing the vulnerabilities of women
and girls to HIV/AIDS and data on the
types, objectives, and duration of
programs to address these issues;
``(III) information on programs to
address the particular needs of
adolescent girls and young women; and
``(IV) programs to prevent gender-
based violence or to assist victims of
gender based violence as part of, or in
coordination with, HIV/AIDS programs;
``(ix) a description of strategies, goals,
programs, and interventions to--
``(I) address the needs and
vulnerabilities of youth populations;
``(II) expand access among young men
and women to evidence-based HIV/AIDS
health care services and HIV prevention
programs, including abstinence education
programs; and
``(III) expand community-based
services to meet the needs of orphans
and of children and adolescents affected
by or vulnerable to HIV/AIDS without
increasing stigmatization;
``(x) a description of--
``(I) the specific strategies funded
to ensure the reduction of HIV infection
among injection drug users;
``(II) the number of injection drug
users, by country, reached by such
strategies; and
``(III) medication-assisted drug
treatment for individuals with HIV or at
risk of HIV;

[[Page 2956]]
122 STAT. 2956

``(xi) a detailed description of program
monitoring, operations research, and impact
evaluation research, including--
``(I) the amount of funding provided
for each research type;
``(II) an analysis of cost-
effectiveness models; and
``(III) conclusions regarding the
efficiency, effectiveness, and quality
of services as derived from previous or
ongoing research and monitoring efforts;
``(xii) building capacity to identify,
investigate, and stop nosocomial transmission of
infectious diseases, including HIV and
tuberculosis; and
``(xiii) a description of staffing levels of
United States government HIV/AIDS teams in
countries with significant HIV/AIDS programs,
including whether or not a full-time coordinator
was on staff for the year.''.

(f) Authorization of Appropriations.--Section 301(b) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7631(b)) is amended--
(1) in paragraph (1), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through 2013'';
and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through 2013''.

(g) Relationship To Assistance Programs To Enhance Nutrition.--
Section 301(c) of such Act is amended to read as follows:
``(c) Food and Nutritional Support.--
``(1) In general.--As indicated in the report produced by
the Institute of Medicine, entitled `PEPFAR Implementation:
Progress and Promise', inadequate caloric intake has been
clearly identified as a principal reason for failure of clinical
response to antiretroviral therapy. In recognition of the impact
of malnutrition as a clinical health issue for many persons
living with HIV/AIDS that is often associated with health and
economic impacts on these individuals and their families, the
Global AIDS Coordinator and the Administrator of the United
States Agency for International Development shall--
``(A) follow World Health Organization guidelines
for HIV/AIDS food and nutrition services;
``(B) integrate nutrition programs with HIV/AIDS
activities through effective linkages among the health,
agricultural, and livelihood sectors and establish
additional services in circumstances in which referrals
are inadequate or impossible;
``(C) provide, as a component of care and treatment
programs for persons with HIV/AIDS, food and nutritional
support to individuals infected with, and affected by,
HIV/AIDS who meet established criteria for nutritional
support (including clinically malnourished children and
adults, and pregnant and lactating women in programs in
need of supplemental support), including--
``(i) anthropometric and dietary assessment;
``(ii) counseling; and
``(iii) therapeutic and supplementary feeding;

[[Page 2957]]
122 STAT. 2957

``(D) provide food and nutritional support for
children affected by HIV/AIDS and to communities and
households caring for children affected by HIV/AIDS; and
``(E) in communities where HIV/AIDS and food
insecurity are highly prevalent, support programs to
address these often intersecting health problems through
community-based assistance programs, with an emphasis on
sustainable approaches.
``(2) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401, there are
authorized to be appropriated to the President such sums as may
be necessary for each of the fiscal years 2009 through 2013 to
carry out this subsection.''.

(h) Eligibility for Assistance.--Section 301(d) of such Act is
amended to read as follows:
``(d) Eligibility for Assistance.--An organization, including a
faith-based organization, that is otherwise eligible to receive
assistance under section 104A of the Foreign Assistance Act of 1961,
under this Act, or under any amendment made by this Act or by the Tom
Lantos and Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, for HIV/
AIDS prevention, treatment, or care--
``(1) shall not be required, as a condition of receiving
such assistance--
``(A) to endorse or utilize a multisectoral or
comprehensive approach to combating HIV/AIDS; or
``(B) to endorse, utilize, make a referral to,
become integrated with, or otherwise participate in any
program or activity to which the organization has a
religious or moral objection; and
``(2) [NOTE: Non- discrimination.]  shall not be
discriminated against in the solicitation or issuance of grants,
contracts, or cooperative agreements under such provisions of
law for refusing to meet any requirement described in paragraph
(1).''.
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

(a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to control tuberculosis. In all countries
in which the Government of the United States has established development
programs, particularly in countries with the highest burden of
tuberculosis and other countries with high rates of tuberculosis, the
United States should support the objectives of the Global Plan to Stop
TB, including through achievement of the following goals:
``(1) Reduce by half the tuberculosis death and disease
burden from the 1990 baseline.
``(2) Sustain or exceed the detection of at least 70 percent
of sputum smear-positive cases of tuberculosis and the
successful treatment of at least 85 percent of the cases
detected in countries with established United States Agency for
International Development tuberculosis programs.
``(3) [NOTE: President. Plans.]  In support of the Global
Plan to Stop TB, the President shall establish a comprehensive,
5-year United States strategy to expand and improve United
States efforts to combat tuberculosis globally, including a plan
to support--

[[Page 2958]]
122 STAT. 2958

``(A) the successful treatment of 4,500,000 new
sputum smear tuberculosis patients under DOTS programs
by 2013, primarily through direct support for needed
services, commodities, health workers, and training, and
additional treatment through coordinated multilateral
efforts; and
``(B) the diagnosis and treatment of 90,000 new
multiple drug resistant tuberculosis cases by 2013, and
additional treatment through coordinated multilateral
efforts.''.

(b) Priority To Stop TB Strategy.--Section 104B(e) of such Act is
amended to read as follows:
``(e) Priority To Stop TB Strategy.--In furnishing assistance under
subsection (c), the President shall give priority to--
``(1) direct services described in the Stop TB Strategy,
including expansion and enhancement of Directly Observed
Treatment Short-course (DOTS) coverage, rapid testing, treatment
for individuals infected with both tuberculosis and HIV, and
treatment for individuals with multi-drug resistant tuberculosis
(MDR-TB), strengthening of health systems, use of the
International Standards for Tuberculosis Care by all providers,
empowering individuals with tuberculosis, and enabling and
promoting research to develop new diagnostics, drugs, and
vaccines, and program-based operational research relating to
tuberculosis; and
``(2) funding for the Global Tuberculosis Drug Facility, the
Stop Tuberculosis Partnership, and the Global Alliance for TB
Drug Development.''.

(c) Assistance for the World Health Organization and the Stop
Tuberculosis Partnership.--Section 104B of such Act is amended--
(1) by redesignating subsection (f) as subsection (h); and
(2) by inserting after subsection (e) the following:

``(f) Assistance for the World Health Organization and the Stop
Tuberculosis Partnership.--In carrying out this section, the President,
acting through the Administrator of the United States Agency for
International Development, is authorized to provide increased resources
to the World Health Organization and the Stop Tuberculosis Partnership
to improve the capacity of countries with high rates of tuberculosis and
other affected countries to implement the Stop TB Strategy and specific
strategies related to addressing multiple drug resistant tuberculosis
(MDR-TB) and extensively drug resistant tuberculosis (XDR-TB).''.
(d) Annual Report.--Section 104B of such Act is amended by inserting
after subsection (f), as added by subsection (c) of this section, the
following:
``(g) Annual Report.--The [NOTE: President. Foreign assistance.]
President shall submit an annual report to Congress that describes the
impact of United States foreign assistance on efforts to control
tuberculosis, including--
``(1) the number of tuberculosis cases diagnosed and the
number of cases cured in countries receiving United States
bilateral foreign assistance for tuberculosis control purposes;
``(2) a description of activities supported with United
States tuberculosis resources in each country, including a
description of how those activities specifically contribute to
increasing the number of people diagnosed and treated for
tuberculosis;
``(3) in each country receiving bilateral United States
foreign assistance for tuberculosis control purposes, the
percentage provided for direct tuberculosis services in
countries receiving

[[Page 2959]]
122 STAT. 2959

United States bilateral foreign assistance for tuberculosis
control purposes;
``(4) a description of research efforts and clinical trials
to develop new tools to combat tuberculosis, including
diagnostics, drugs, and vaccines supported by United States
bilateral assistance;
``(5) the number of persons who have been diagnosed and
started treatment for multidrug-resistant tuberculosis in
countries receiving United States bilateral foreign assistance
for tuberculosis control programs;
``(6) a description of the collaboration and coordination of
United States anti-tuberculosis efforts with the World Health
Organization, the Global Fund, and other major public and
private entities within the Stop TB Strategy;
``(7) the constraints on implementation of programs posed by
health workforce shortages and capacities;
``(8) the number of people trained in tuberculosis control;
and
``(9) a breakdown of expenditures for direct patient
tuberculosis services, drugs and other commodities, drug
management, training in diagnosis and treatment, health systems
strengthening, research, and support costs.''.

(e) Definitions.--Section 104B(h) of such Act, as redesignated by
subsection (c), is amended--
(1) in paragraph (1), by striking the period at the end and
inserting the following: ``including--
``(A) low-cost and effective diagnosis, treatment,
and monitoring of tuberculosis;
``(B) a reliable drug supply;
``(C) a management strategy for public health
systems;
``(D) health system strengthening;
``(E) promotion of the use of the International
Standards for Tuberculosis Care by all care providers;
``(F) bacteriology under an external quality
assessment framework;
``(G) short-course chemotherapy; and
``(H) sound reporting and recording systems.''; and
(2) by redesignating paragraph (5) as paragraph (6); and
(3) by inserting after paragraph (4) the following:
``(5) Stop tb strategy.--The term `Stop TB Strategy' means
the 6-point strategy to reduce tuberculosis developed by the
World Health Organization, which is described in the Global Plan
to Stop TB 2006-2015: Actions for Life, a comprehensive plan
developed by the Stop TB Partnership that sets out the actions
necessary to achieve the millennium development goal of cutting
tuberculosis deaths and disease burden in half by 2015.''.

(f) Authorization of Appropriations.--Section 302 (b) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7632(b)) is amended--
(1) in paragraph (1), by striking ``such sums as may be
necessary for each of the fiscal years 2004 through 2008'' and
inserting ``a total of $4,000,000,000 for the 5-year period
beginning on October 1, 2008.''; and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013.''.

[[Page 2960]]
122 STAT. 2960

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

(a) Amendment to the Foreign Assistance Act of 1961.--Section
104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-
4(b)) [NOTE: 22 USC 2151b-4.]  is amended by inserting ``treatment,''
after ``control,''.

(b) Authorization of Appropriations.--Section 303 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
(1) in subsection (b)--
(A) in paragraph (1), by striking ``such sums as may
be necessary for fiscal years 2004 through 2008'' and
inserting ``$5,000,000,000 during the 5-year period
beginning on October 1, 2008''; and
(B) in paragraph (3), by striking ``fiscal years
2004 through 2008'' and inserting ``fiscal years 2009
through 2013''; and
(2) by adding at the end the following:

``(c) [NOTE: 22 USC 7633.]  Statement of Policy.--Providing
assistance for the prevention, control, treatment, and the ultimate
eradication of malaria is--
``(1) a major objective of the foreign assistance program of
the United States; and
``(2) 1 component of a comprehensive United States global
health strategy to reduce disease burdens and strengthen
communities around the world.

``(d) [NOTE: President.]  Development of a Comprehensive 5-Year
Strategy.--The President shall establish a comprehensive, 5-year
strategy to combat global malaria that--
``(1) strengthens the capacity of the United States to be an
effective leader of international efforts to reduce malaria
burden;
``(2) maintains sufficient flexibility and remains
responsive to the ever-changing nature of the global malaria
challenge;
``(3) includes specific objectives and multisectoral
approaches and strategies to reduce the prevalence, mortality,
incidence, and spread of malaria;
``(4) describes how this strategy would contribute to the
United States' overall global health and development goals;
``(5) clearly explains how outlined activities will interact
with other United States Government global health activities,
including the 5-year global AIDS strategy required under this
Act;
``(6) expands public-private partnerships and leverage of
resources;
``(7) coordinates among relevant Federal agencies to
maximize human and financial resources and to reduce duplication
among these agencies, foreign governments, and international
organizations;
``(8) coordinates with other international entities,
including the Global Fund;
``(9) maximizes United States capabilities in the areas of
technical assistance and training and research, including
vaccine research; and
``(10) establishes priorities and selection criteria for the
distribution of resources based on factors such as--
``(A) the size and demographics of the population
with malaria;

[[Page 2961]]
122 STAT. 2961

``(B) the needs of that population;
``(C) the country's existing infrastructure; and
``(D) the ability to closely coordinate United
States Government efforts with national malaria control
plans of partner countries.''.
SEC. 304. MALARIA RESPONSE COORDINATOR.

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

``(a) In General.--There [NOTE: Establishment. Government
organization. President.]  is established within the United States
Agency for International Development a Coordinator of United States
Government Activities to Combat Malaria Globally (referred to in this
section as the `Malaria Coordinator'), who shall be appointed by the
President.

``(b) Authorities.--The Malaria Coordinator, acting through
nongovernmental organizations (including faith-based and community-based
organizations), partner country finance, health, and other relevant
ministries, and relevant executive branch agencies as may be necessary
and appropriate to carry out this section, is authorized to--
``(1) operate internationally to carry out prevention, care,
treatment, support, capacity development, and other activities
to reduce the prevalence, mortality, and incidence of malaria;
``(2) provide grants to, and enter into contracts and
cooperative agreements with, nongovernmental organizations
(including faith-based organizations) to carry out this section;
and
``(3) transfer and allocate executive branch agency funds
that have been appropriated for the purposes described in
paragraphs (1) and (2).

``(c) Duties.--
``(1) In general.--The Malaria Coordinator has primary
responsibility for the oversight and coordination of all
resources and international activities of the United States
Government relating to efforts to combat malaria.
``(2) Specific duties.--The Malaria Coordinator shall--
``(A) facilitate program and policy coordination of
antimalarial efforts among relevant executive branch
agencies and nongovernmental organizations by auditing,
monitoring, and evaluating such programs;
``(B) ensure that each relevant executive branch
agency undertakes antimalarial programs primarily in
those areas in which the agency has the greatest
expertise, technical capability, and potential for
success;
``(C) coordinate relevant executive branch agency
activities in the field of malaria prevention and
treatment;
``(D) coordinate planning, implementation, and
evaluation with the Global AIDS Coordinator in countries
in which both programs have a significant presence;
``(E) coordinate with national governments,
international agencies, civil society, and the private
sector; and
``(F) [NOTE: Criteria.]  establish due diligence
criteria for all recipients of funds appropriated by the
Federal Government for malaria assistance.

[[Page 2962]]
122 STAT. 2962

``(d) Assistance for the World Health Organization.--In carrying out
this section, the President may provide financial assistance to the Roll
Back Malaria Partnership of the World Health Organization to improve the
capacity of countries with high rates of malaria and other affected
countries to implement comprehensive malaria control programs.
``(e) Coordination of Assistance Efforts.--In carrying out this
section and in accordance with section 104C of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator shall
coordinate the provision of assistance by working with--
``(1) relevant executive branch agencies, including--
``(A) the Department of State (including the Office
of the Global AIDS Coordinator);
``(B) the Department of Health and Human Services;
``(C) the Department of Defense; and
``(D) the Office of the United States Trade
Representative;
``(2) relevant multilateral institutions, including--
``(A) the World Health Organization;
``(B) the United Nations Children's Fund;
``(C) the United Nations Development Programme;
``(D) the Global Fund;
``(E) the World Bank; and
``(F) the Roll Back Malaria Partnership;
``(3) program delivery and efforts to lift barriers that
would impede effective and comprehensive malaria control
programs; and
``(4) partner or recipient country governments and national
entities including universities and civil society organizations
(including faith- and community-based organizations).

``(f) Research.--To carry out this section, the Malaria Coordinator,
in accordance with section 104C of the Foreign Assistance Act of 1961
(22 U.S.C. 1151d-4), shall ensure that operations and implementation
research conducted under this Act will closely complement the clinical
and program research being undertaken by the National Institutes of
Health. The Centers for Disease Control and Prevention should advise the
Malaria Coordinator on priorities for operations and implementation
research and should be a key implementer of this research.
``(g) Monitoring.--To ensure that adequate malaria controls are
established and implemented, the Centers for Disease Control and
Prevention should advise the Malaria Coordinator on monitoring,
surveillance, and evaluation activities and be a key implementer of such
activities under this Act. Such activities shall complement, rather than
duplicate, the work of the World Health Organization.
``(h) Annual Report.--
``(1) Submission.--Not [NOTE: President.]  later than 1
year after the date of the enactment of the Tom Lantos and Henry
J. Hyde United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act of 2008, and
annually thereafter, the President shall submit a report to the
appropriate congressional committees that describes United
States assistance for the prevention, treatment, control, and
elimination of malaria.
``(2) Contents.--The report required under paragraph (1)
shall describe--

[[Page 2963]]
122 STAT. 2963

``(A) the countries and activities to which malaria
resources have been allocated;
``(B) the number of people reached through malaria
assistance programs, including data on children and
pregnant women;
``(C) research efforts to develop new tools to
combat malaria, including drugs and vaccines;
``(D) the collaboration and coordination of United
States antimalarial efforts with the World Health
Organization, the Global Fund, the World Bank, other
donor governments, major private efforts, and relevant
executive agencies;
``(E) the coordination of United States antimalarial
efforts with the national malarial strategies of other
donor or partner governments and major private
initiatives;
``(F) the estimated impact of United States
assistance on childhood mortality and morbidity from
malaria;
``(G) the coordination of antimalarial efforts with
broader health and development programs; and
``(H) the constraints on implementation of programs
posed by health workforce shortages or capacities; and
``(I) the number of personnel trained as health
workers and the training levels achieved.''.
SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.

Section 212(a)(1)(A)(i) of the Immigration and Nationality Act (8
U.S.C. 1182(a)(1)(A)(i)) is amended by striking ``, which shall include
infection with the etiologic agent for acquired immune deficiency
syndrome,'' and inserting a semicolon.
SEC. 306. CLERICAL AMENDMENT.

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

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

SEC. 307. REQUIREMENTS.

Section 312(b) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is amended by
striking paragraphs (1), (2), and (3) and inserting the following:
``(1) establish a target for the prevention and treatment of
mother-to-child transmission of HIV that, by 2013, will reach at
least 80 percent of pregnant women in those countries most
affected by HIV/AIDS in which the United States has HIV/AIDS
programs;
``(2) establish a target that, by 2013, the proportion of
children receiving care and treatment under this Act is
proportionate to their numbers within the population of HIV
infected individuals in each country;

[[Page 2964]]
122 STAT. 2964

``(3) integrate care and treatment with prevention of
mother-to-child transmission of HIV programs to improve outcomes
for HIV-affected women and families as soon as is feasible and
support strategies that promote successful follow-up and
continuity of care of mother and child;
``(4) expand programs designed to care for children orphaned
by, affected by, or vulnerable to HIV/AIDS;
``(5) ensure that women in prevention of mother-to-child
transmission of HIV programs are provided with, or referred to,
appropriate maternal and child services; and
``(6) develop a timeline for expanding access to more
effective regimes to prevent mother-to-child transmission of
HIV, consistent with the national policies of countries in which
programs are administered under this Act and the goal of
achieving universal use of such regimes as soon as possible.''.
SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION OF HIV.

Section 313(a) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) is amended by
striking ``5 years'' and inserting ``10 years''.
SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT PANEL.

Section 312 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) is amended by
adding at the end the following:
``(c) Prevention of Mother-to-Child Transmission Expert Panel.--
``(1) Establishment.--The Global AIDS Coordinator shall
establish a panel of experts to be known as the Prevention of
Mother-to-Child Transmission Panel (referred to in this
subsection as the `Panel') to--
``(A) provide an objective review of activities to
prevent mother-to-child transmission of HIV; and
``(B) provide recommendations to the Global AIDS
Coordinator and to the appropriate congressional
committees for scale-up of mother-to-child transmission
prevention services under this Act in order to achieve
the target established in subsection (b)(1).
``(2) Membership.--The [NOTE: Appointments. Deadline.]
Panel shall be convened and chaired by the Global AIDS
Coordinator, who shall serve as a nonvoting member. The Panel
shall consist of not more than 15 members (excluding the Global
AIDS Coordinator), to be appointed by the Global AIDS
Coordinator not later than 1 year after the date of the
enactment of this Act, including--
``(A) 2 members from the Department of Health and
Human Services with expertise relating to the prevention
of mother-to-child transmission activities;
``(B) 2 members from the United States Agency for
International Development with expertise relating to the
prevention of mother-to-child transmission activities;
``(C) 2 representatives from among health ministers
of national governments of foreign countries in which
programs under this Act are administered;
``(D) 3 members representing organizations
implementing prevention of mother-to-child transmission
activities under this Act;

[[Page 2965]]
122 STAT. 2965

``(E) 2 health care researchers with expertise
relating to global HIV/AIDS activities; and
``(F) representatives from among patient advocate
groups, health care professionals, persons living with
HIV/AIDS, and non-governmental organizations with
expertise relating to the prevention of mother-to-child
transmission activities, giving priority to individuals
in foreign countries in which programs under this Act
are administered.
``(3) Duties of panel.--The Panel shall--
``(A) assess the effectiveness of current activities
in reaching the target described in subsection (b)(1);
``(B) review scientific evidence related to the
provision of mother-to-child transmission prevention
services, including programmatic data and data from
clinical trials;
``(C) review and assess ways in which the Office of
the United States Global AIDS Coordinator collaborates
with international and multilateral entities on efforts
to prevent mother-to-child transmission of HIV in
affected countries;
``(D) identify barriers and challenges to increasing
access to mother-to-child transmission prevention
services and evaluate potential mechanisms to alleviate
those barriers and challenges;
``(E) identify the extent to which stigma has
hindered pregnant women from obtaining HIV counseling
and testing or returning for results, and provide
recommendations to address such stigma and its effects;
``(F) identify opportunities to improve linkages
between mother-to-child transmission prevention services
and care and treatment programs; and
``(G) recommend specific activities to facilitate
reaching the target described in subsection (b)(1).
``(4) Report.--
``(A) In general.--Not later than 1 year after the
date on which the Panel is first convened, the Panel
shall submit a report containing a detailed statement of
the recommendations, findings, and conclusions of the
Panel to the appropriate congressional committees.
``(B) Availability.--The [NOTE: Public
information.]  report submitted under subparagraph (A)
shall be made available to the public.
``(C) Consideration by coordinator.--The Coordinator
shall--
``(i) consider any recommendations contained
in the report submitted under subparagraph (A);
and
``(ii) include in the annual report required
under section 104A(f) of the Foreign Assistance
Act of 1961 a description of the activities
conducted in response to the recommendations made
by the Panel and an explanation of any
recommendations not implemented at the time of the
report.
``(5) Authorization of appropriations.--There are authorized
to be appropriated to the Panel such sums as may be necessary
for each of the fiscal years 2009 through 2011 to carry out this
section.
``(6) Termination.--The Panel shall terminate on the date
that is 60 days after the date on which the Panel submits

[[Page 2966]]
122 STAT. 2966

the report to the appropriate congressional committees under
paragraph (4).''.

TITLE IV--FUNDING ALLOCATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

(a) In General.--Section 401(a) of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7671(a)) is amended by striking ``$3,000,000,000 for each of the fiscal
years 2004 through 2008'' and inserting ``$48,000,000,000 for the 5-year
period beginning on October 1, 2008''.
(b) Sense of Congress.--It is the sense of the Congress that the
appropriations authorized under section 401(a) of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, as
amended by subsection (a), should be allocated among fiscal years 2009
through 2013 in a manner that allows for the appropriations to be
gradually increased in a manner that is consistent with program
requirements, absorptive capacity, and priorities set forth in such Act,
as amended by this Act.
SEC. 402. SENSE OF CONGRESS.

Section 402(b) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) is amended by
striking ``an effective distribution of such amounts would be'' and all
that follows through ``10 percent of such amounts'' and inserting ``10
percent should be used''.
SEC. 403. ALLOCATION OF FUNDS.

Section 403 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is amended--
(1) by amending subsection (a) to read as follows:

``(a) Balanced Funding Requirement.--
``(1) In general.--The Global AIDS Coordinator shall--
``(A) provide balanced funding for prevention
activities for sexual transmission of HIV/AIDS; and
``(B) ensure that activities promoting abstinence,
delay of sexual debut, monogamy, fidelity, and partner
reduction are implemented and funded in a meaningful and
equitable way in the strategy for each host country
based on objective epidemiological evidence as to the
source of infections and in consultation with the
government of each host county involved in HIV/AIDS
prevention activities.
``(2) Prevention strategy.--
``(A) Establishment.--In carrying out paragraph (1),
the Global AIDS Coordinator shall establish an HIV
sexual transmission prevention strategy governing the
expenditure of funds authorized under this Act to
prevent the sexual transmission of HIV in any host
country with a generalized epidemic.
``(B) Report.--In each host country described in
subparagraph (A), if the strategy established under
subparagraph (A) provides less than 50 percent of the
funds described in subparagraph (A) for activities
promoting abstinence, delay of sexual debut, monogamy,

[[Page 2967]]
122 STAT. 2967

fidelity, and partner reduction, the Global AIDS
Coordinator shall, not later than 30 days after the
issuance of this strategy, report to the appropriate
congressional committees on the justification for this
decision.
``(3) Exclusion.--Programs and activities that implement or
purchase new prevention technologies or modalities, such as
medical male circumcision, public education about risks to
acquire HIV infection from blood exposures, promoting universal
precautions, investigating suspected nosocomial infections, pre-
exposure pharmaceutical prophylaxis to prevent transmission of
HIV, or microbicides and programs and activities that provide
counseling and testing for HIV or prevent mother-to-child
prevention of HIV, shall not be included in determining
compliance with paragraph (2).
``(4) Report.--Not [NOTE: President.]  later than 1 year
after the date of the enactment of the Tom Lantos and Henry J.
Hyde United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act of 2008, and
annually thereafter as part of the annual report required under
section 104A(e) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b-2(e)), the President shall--
``(A) submit a report on the implementation of
paragraph (2) for the most recently concluded fiscal
year to the appropriate congressional committees; and
``(B) [NOTE: Public information.]  make the report
described in subparagraph (A) available to the
public.'';
(2) in subsection (b)--
(A) by striking ``fiscal years 2006 through 2008''
and inserting ``fiscal years 2009 through 2013''; and
(B) by striking ``vulnerable children affected by''
and inserting ``other children affected by, or
vulnerable to,''; and
(3) by adding at the end the following:

``(c) Funding Allocation.--For each of the fiscal years 2009 through
2013, more than half of the amounts appropriated for bilateral global
HIV/AIDS assistance pursuant to section 401 shall be expended for--
``(1) antiretroviral treatment for HIV/AIDS;
``(2) clinical monitoring of HIV-seropositive people not in
need of antiretroviral treatment;
``(3) care for associated opportunistic infections;
``(4) nutrition and food support for people living with HIV/
AIDS; and
``(5) other essential HIV/AIDS-related medical care for
people living with HIV/AIDS.

``(d) Treatment, Prevention, and Care Goals.--For each of the fiscal
years 2009 through 2013--
``(1) the treatment goal under section 402(a)(3) shall be
increased above 2,000,000 by at least the percentage increase in
the amount appropriated for bilateral global HIV/AIDS assistance
for such fiscal year compared with fiscal year 2008;
``(2) any increase in the treatment goal under section
402(a)(3) above the percentage increase in the amount
appropriated for bilateral global HIV/AIDS assistance for such
fiscal year compared with fiscal year 2008 shall be based on
long-

[[Page 2968]]
122 STAT. 2968

term requirements, epidemiological evidence, the share of
treatment needs being met by partner governments and other
sources of treatment funding, and other appropriate factors;
``(3) the treatment goal under section 402(a)(3) shall be
increased above the number calculated under paragraph (1) by the
same percentage that the average United States Government cost
per patient of providing treatment in countries receiving
bilateral HIV/AIDS assistance has decreased compared with fiscal
year 2008; and
``(4) the prevention and care goals established in clauses
(i) and (iv) of section 104A(b)(1)(A) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-2(b)(1)(A)) shall be increased
consistent with epidemiological evidence and available
resources.''.

TITLE V--MISCELLANEOUS

SEC. 501. [NOTE: 8 USC 1351 note.]  MACHINE READABLE VISA FEES.

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

(b) Deposit of Amounts.--Notwithstanding section 140(a)(2) of the
Foreign Relations Authorization Act, Fiscal Years 1994 and 1995 (Public
Law 103-236; 8 U.S.C. 1351 note), fees collected under the authority of
subsection (a) shall be deposited in the Treasury.

TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

SEC. 601. [NOTE: 25 USC 443c.]  EMERGENCY PLAN FOR INDIAN SAFETY
AND HEALTH.

(a) Establishment of Fund.--There is established in the Treasury of
the United States a fund, to be known as the ``Emergency Fund for Indian
Safety and Health'' (referred to in this section as the ``Fund''),
consisting of such amounts as are appropriated to the Fund under
subsection (b).
(b) Transfers to Fund.--
(1) In general.--There [NOTE: Effective date.]  is
authorized to be appropriated to the Fund, out of funds of the
Treasury not otherwise appropriated, $2,000,000,000 for the 5-
year period beginning on October 1, 2008.
(2) Availability of amounts.--Amounts deposited in the Fund
under this section shall--
(A) be made available without further appropriation;
(B) be in addition to amounts made available under
any other provision of law; and
(C) remain available until expended.

[[Page 2969]]
122 STAT. 2969

(c) Expenditures From Fund.--On request by the Attorney General, the
Secretary of the Interior, or the Secretary of Health and Human
Services, the Secretary of the Treasury shall transfer from the Fund to
the Attorney General, the Secretary of the Interior, or the Secretary of
Health and Human Services, as appropriate, such amounts as the Attorney
General, the Secretary of the Interior, or the Secretary of Health and
Human Services determines to be necessary to carry out the emergency
plan under subsection (f).
(d) Transfers of Amounts.--
(1) In general.--The amounts required to be transferred to
the Fund under this section shall be transferred at least
monthly from the general fund of the Treasury to the Fund on the
basis of estimates made by the Secretary of the Treasury.
(2) Adjustments.--Proper adjustment shall be made in amounts
subsequently transferred to the extent prior estimates were in
excess of or less than the amounts required to be transferred.

(e) Remaining Amounts.--Any amounts remaining in the Fund on
September 30 of an applicable fiscal year may be used by the Attorney
General, the Secretary of the Interior, or the Secretary of Health and
Human Services to carry out the emergency plan under subsection (f) for
any subsequent fiscal year.
(f) Emergency Plan.--Not [NOTE: Deadline.]  later than 1 year
after the date of enactment of this Act, the Attorney General, the
Secretary of the Interior, and the Secretary of Health and Human
Services, in consultation with Indian tribes (as defined in section 4 of
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
450b)), shall jointly establish an emergency plan that addresses law
enforcement, water, and health care needs of Indian tribes under which,
for each of fiscal years 2010 through 2019, of amounts in the Fund--
(1) the Attorney General shall use--
(A) 18.5 percent for the construction,
rehabilitation, and replacement of Federal Indian
detention facilities;
(B) 1.5 percent to investigate and prosecute crimes
in Indian country (as defined in section 1151 of title
18, United States Code);
(C) 1.5 percent for use by the Office of Justice
Programs for Indian and Alaska Native programs; and
(D) 0.5 percent to provide assistance to--
(i) parties to cross-deputization or other
cooperative agreements between State or local
governments and Indian tribes (as defined in
section 102 of the Federally Recognized Indian
Tribe List Act of 1994 (25 U.S.C. 479a)) carrying
out law enforcement activities in Indian country;
and
(ii) [NOTE: Alaska.]  the State of Alaska
(including political subdivisions of that State)
for carrying out the Village Public Safety Officer
Program and law enforcement activities on Alaska
Native land (as defined in section 3 of Public Law
103-399 (25 U.S.C. 3902));
(2) the Secretary of the Interior shall--
(A) deposit 15.5 percent in the public safety and
justice account of the Bureau of Indian Affairs for use
by the Office of Justice Services of the Bureau in
providing law

[[Page 2970]]
122 STAT. 2970

enforcement or detention services, directly or through
contracts or compacts with Indian tribes under the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.); and
(B) use 50 percent to implement requirements of
Indian water settlement agreements that are approved by
Congress (or the legislation to implement such an
agreement) under which the United States shall plan,
design, rehabilitate, or construct, or provide financial
assistance for the planning, design, rehabilitation, or
construction of, water supply or delivery infrastructure
that will serve an Indian tribe (as defined in section 4
of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b)); and
(3) the Secretary of Health and Human Services, acting
through the Director of the Indian Health Service, shall use
12.5 percent to provide, directly or through contracts or
compacts with Indian tribes under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.)--
(A) contract health services;
(B) construction, rehabilitation, and replacement of
Indian health facilities; and
(C) domestic and community sanitation facilities
serving members of Indian tribes (as defined in section
4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b)) pursuant to section 7
of the Act of August 5, 1954 (42 U.S.C. 2004a).

Approved July 30, 2008.

LEGISLATIVE HISTORY--H.R. 5501 (S. 2731):
---------------------------------------------------------------------------

HOUSE REPORTS: No. 110-546, Pts. 1 and 2 (Comm. on Foreign Affairs).
SENATE REPORTS: No. 110-325 accompanying S. 2731 (Comm. on Foreign
Relations).
CONGRESSIONAL RECORD, Vol. 154 (2008):
Apr. 2, considered and passed House.
July 16, considered and passed Senate, amended, in lieu of
S. 2731.
July 24, House concurred in Senate amendment.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 44 (2008):
July 30, Presidential remarks.