[Congressional Bills 110th Congress]
[From the U.S. Government Printing Office]
[H.R. 5501 Enrolled Bill (ENR)]
H.R.5501
One Hundred Tenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Thursday,
the third day of January, two thousand and eight
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(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:

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TITLE I

-POLICY PLANNING AND COORDINATION

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TITLE II

-SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE

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health policies and health systems of partner countries.

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Subtitle A--General Assistance and Programs

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TITLE III

-BILATERAL EFFORTS

Section 2 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by
adding at the end the following:
``(29) On May 27, 2003, the President signed this Act into law,
launching the largest international public health program of its
kind ever created.
``(30) Between 2003 and 2008, the United States, through the
President's Emergency Plan for AIDS Relief (PEPFAR) and in
conjunction with other bilateral programs and the multilateral
Global Fund has helped to--
``(A) provide antiretroviral therapy for over 1,900,000
people;
``(B) ensure that over 150,000 infants, most of whom would
have likely been infected with HIV during pregnancy or
childbirth, were not infected; and
``(C) provide palliative care and HIV prevention assistance
to millions of other people.
``(31) While United States leadership in the battles against
HIV/AIDS, tuberculosis, and malaria has had an enormous impact,
these diseases continue to take a terrible toll on the human race.
``(32) According to the 2007 AIDS Epidemic Update of the Joint
United Nations Programme on HIV/AIDS (UNAIDS)--
``(A) an estimated 2,100,000 people died of AIDS-related
causes in 2007; and
``(B) an estimated 2,500,000 people were newly infected
with HIV during that year.
``(33) According to the World Health Organization, malaria
kills more than 1,000,000 people per year, 70 percent of whom are
children under 5 years of age.
``(34) According to the World Health Organization, \1/3\ of the
world's population is infected with the tuberculosis bacterium, and
tuberculosis is 1 of the greatest infectious causes of death of
adults worldwide, killing 1,600,000 people per year.
``(35) Efforts to promote abstinence, fidelity, the correct and
consistent use of condoms, the delay of sexual debut, and the
reduction of concurrent sexual partners represent important
elements of strategies to prevent the transmission of HIV/AIDS.
``(36) According to UNAIDS--
``(A) women and girls make up nearly 60 percent of persons
in sub-Saharan Africa who are HIV positive;
``(B) women and girls are more biologically, economically,
and socially vulnerable to HIV infection; and
``(C) gender issues are critical components in the effort
to prevent HIV/AIDS and to care for those affected by the
disease.
``(37) Children who have lost a parent to HIV/AIDS, who are
otherwise directly affected by the disease, or who live in areas of
high HIV prevalence may be vulnerable to the disease or its
socioeconomic effects.
``(38) Lack of health capacity, including insufficient
personnel and inadequate infrastructure, in sub-Saharan Africa and
other regions of the world is a critical barrier that limits the
effectiveness of efforts to combat HIV/AIDS, tuberculosis, and
malaria, and to achieve other global health goals.
``(39) On March 30, 2007, the Institute of Medicine of the
National Academies released a report entitled `PEPFAR
Implementation: Progress and Promise', which found that budget
allocations setting percentage levels for spending on prevention,
care, and treatment and for certain subsets of activities within
the prevention category--
``(A) have `adversely affected implementation of the U.S.
Global AIDS Initiative';
``(B) have inhibited comprehensive, integrated, evidence
based approaches;
``(C) `have been counterproductive';
``(D) `may have been helpful initially in ensuring a
balance of attention to activities within the 4 categories of
prevention, treatment, care, and orphans and vulnerable
children';
``(E) `have also limited PEPFAR's ability to tailor its
activities in each country to the local epidemic and to
coordinate with the level of activities in the countries'
national plans'; and
``(F) should be removed by Congress and replaced with more
appropriate mechanisms that--
``(i) `ensure accountability for results from Country
Teams to the U.S. Global AIDS Coordinator and to Congress';
and
``(ii) `ensure that spending is directly linked to and
commensurate with necessary efforts to achieve both country
and overall performance targets for prevention, treatment,
care, and orphans and vulnerable children'.
``(40) The United States Government has endorsed the principles
of harmonization in coordinating efforts to combat HIV/AIDS
commonly referred to as the `Three Ones', which includes--
``(A) 1 agreed HIV/AIDS action framework that provides the
basis for coordination of the work of all partners;
``(B) 1 national HIV/AIDS coordinating authority, with a
broadbased multisectoral mandate; and
``(C) 1 agreed HIV/AIDS country-level monitoring and
evaluating system.
``(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis and
Other Related Infectious Diseases, of April 26-27, 2001 (referred
to in this Act as the `Abuja Declaration'), the Heads of State and
Government of the Organization of African Unity (OAU)--
``(A) declared that they would `place the fight against
HIV/AIDS at the forefront and as the highest priority issue in
our respective national development plans';
``(B) committed `TO TAKE PERSONAL RESPONSIBILITY AND
PROVIDE LEADERSHIP for the activities of the National AIDS
Commissions/Councils';
``(C) resolved `to lead from the front the battle against
HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by
personally ensuring that such bodies were properly convened in
mobilizing our societies as a whole and providing focus for
unified national policymaking and programme implementation,
ensuring coordination of all sectors at all levels with a
gender perspective and respect for human rights, particularly
to ensure equal rights for people living with HIV/AIDS'; and
``(D) pledged `to set a target of allocating at least 15%
of our annual budget to the improvement of the health
sector'.''.

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TITLE VI

-EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

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

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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.''.

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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.

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Section 1(f)(2) of the State Department Basic Authorities Act of
1956 (22 U.S.C. 2651a(f)(2)) is amended--
(1) in subparagraph (A), by inserting ``, partner country
finance, health, and other relevant ministries,'' after ``community
based organizations)'' each place it appears;
(2) in subparagraph (B)(ii)--
(A) by striking subclauses (IV) and (V);
(B) by inserting after subclause (III) the following:
``(IV) Establishing an interagency working group on
HIV/AIDS headed by the Global AIDS Coordinator and
comprised of representatives from the United States
Agency for International Development and the Department
of Health and Human Services, for the purposes of
coordination of activities relating to HIV/AIDS,
including--
``(aa) meeting regularly to review progress in
partner countries toward HIV/AIDS prevention,
treatment, and care objectives;
``(bb) participating in the process of
identifying countries to consider for increased
assistance based on the epidemiology of HIV/AIDS in
those countries, including clear evidence of a
public health threat, as well as government
commitment to address the HIV/AIDS problem,
relative need, and coordination and joint planning
with other significant actors;
``(cc) assisting the Coordinator in the
evaluation, execution, and oversight of country
operational plans;
``(dd) reviewing policies that may be obstacles
to reaching targets set forth for HIV/AIDS
prevention, treatment, and care; and
``(ee) consulting with representatives from
additional relevant agencies, including the
National Institutes of Health, the Health Resources
and Services Administration, the Department of
Labor, the Department of Agriculture, the
Millennium Challenge Corporation, the Peace Corps,
and the Department of Defense.
``(V) Coordinating overall United States HIV/AIDS
policy and programs, including ensuring the
coordination of relevant executive branch agency
activities in the field, with efforts led by partner
countries, and with the assistance provided by other
relevant bilateral and multilateral aid agencies and
other donor institutions to promote harmonization with
other programs aimed at preventing and treating HIV/
AIDS and other health challenges, improving primary
health, addressing food security, promoting education
and development, and strengthening health care
systems.'';
(C) by redesignating subclauses (VII) and VIII) as
subclauses (IX) and (XII), respectively;
(D) by inserting after subclause (VI) the following:
``(VII) Holding annual consultations with
nongovernmental organizations in partner countries that
provide services to improve health, and advocating on
behalf of the individuals with HIV/AIDS and those at
particular risk of contracting HIV/AIDS, including
organizations with members who are living with HIV/
AIDS.
``(VIII) Ensuring, through interagency and
international coordination, that HIV/AIDS programs of
the United States are coordinated with, and
complementary to, the delivery of related global
health, food security, development, and education.'';
(E) in subclause (IX), as redesignated by subparagraph
(C)--
(i) by inserting ``Vietnam,'' after ``Uganda,'';
(ii) by inserting after ``of 2003'' the following:
``and other countries in which the United States is
implementing HIV/AIDS programs as part of its foreign
assistance program''; and
(iii) by adding at the end the following: ``In
designating additional countries under this subparagraph,
the President shall give priority to those countries in
which there is a high prevalence of HIV or risk of
significantly increasing incidence of HIV within the
general population and inadequate financial means within
the country.'';
(F) by inserting after subclause (IX), as redesignated by
subparagraph (C), the following:
``(X) Working with partner countries in which the
HIV/AIDS epidemic is prevalent among injection drug
users to establish, as a national priority, national
HIV/AIDS prevention programs.
``(XI) Working with partner countries in which the
HIV/AIDS epidemic is prevalent among individuals
involved in commercial sex acts to establish, as a
national priority, national prevention programs,
including education, voluntary testing, and counseling,
and referral systems that link HIV/AIDS programs with
programs to eradicate trafficking in persons and
support alternatives to prostitution.'';
(G) in subclause (XII), as redesignated by subparagraph
(C), by striking ``funds section'' and inserting ``funds
appropriated for HIV/ AIDS assistance pursuant to the
authorization of appropriations under section 401 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7671)''; and
(H) by adding at the end the following:
``(XIII) Publicizing updated drug pricing data to
inform the purchasing decisions of pharmaceutical
procurement partners.''.

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Section 102 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) is amended by
adding at the end the following:
``(d) Sense of Congress.--It is the sense of Congress that--
``(1) full-time country level coordinators, preferably with
management experience, should head each HIV/AIDS country team for
United States missions overseeing significant HIV/AIDS programs;
``(2) foreign service nationals provide critically important
services in the design and implementation of United States country-
level HIV/AIDS programs and their skills and experience as public
health professionals should be recognized within hiring and
compensation practices; and
``(3) staffing levels for United States country-level HIV/AIDS
teams should be adequately maintained to fulfill oversight and
other obligations of the positions.''.
PARTNERSHIPS

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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''.

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TUBERCULOSIS AND MALARIA.
(a) Findings; Sense of Congress.--Section 202(a) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7622(a)) is amended to read as follows:
``(a) Findings; Sense of Congress.--
``(1) Findings.--Congress makes the following findings:
``(A) The establishment of the Global Fund in January 2002
is consistent with the general principles for an international
AIDS trust fund first outlined by Congress in the Global AIDS
and Tuberculosis Relief Act of 2000 (Public Law 106-264).
``(B) The Global Fund is an innovative financing mechanism
which--
``(i) has made progress in many areas in combating HIV/
AIDS, tuberculosis, and malaria; and
``(ii) represents the multilateral component of this
Act, extending United States efforts to more than 130
countries around the world.
``(C) The Global Fund and United States bilateral
assistance programs--
``(i) are demonstrating increasingly effective
coordination, with each possessing certain comparative
advantages in the fight against HIV/AIDS, tuberculosis, and
malaria; and
``(ii) often work most effectively in concert with each
other.
``(D) The United States Government--
``(i) is the largest supporter of the Global Fund in
terms of resources and technical support;
``(ii) made the founding contribution to the Global
Fund; and
``(iii) is fully committed to the success of the Global
Fund as a multilateral public-private partnership.
``(2) Sense of congress.--It is the sense of Congress that--
``(A) transparency and accountability are crucial to the
long-term success and viability of the Global Fund;
``(B) the Global Fund has made significant progress toward
addressing concerns raised by the Government Accountability
Office by--
``(i) improving risk assessment and risk management
capabilities;
``(ii) providing clearer guidance for and oversight of
Local Fund Agents; and
``(iii) strengthening the Office of the Inspector
General for the Global Fund;
``(C) the provision of sufficient resources and authority
to the Office of the Inspector General for the Global Fund to
ensure that office has the staff and independence necessary to
carry out its mandate will be a measure of the commitment of
the Global Fund to transparency and accountability;
``(D) regular, publicly published financial, programmatic,
and reporting audits of the Fund, its grantees, and Local Fund
Agents are also important benchmarks of transparency;
``(E) the Global Fund should establish and maintain a
system to track--
``(i) the amount of funds disbursed to each
subrecipient on the grant's fiscal cycle; and
``(ii) the distribution of resources, by grant and
principal recipient, for prevention, care, treatment, drug
and commodity purchases, and other purposes;
``(F) relevant national authorities in recipient countries
should exempt from duties and taxes all products financed by
Global Fund grants and procured by any principal recipient or
subrecipient for the purpose of carrying out such grants;
``(G) the Global Fund, UNAIDS, and the Global AIDS
Coordinator should work together to standardize program
indicators wherever possible;
``(H) for purposes of evaluating total amounts of funds
contributed to the Global Fund under subsection (d)(4)(A)(i),
the timetable for evaluations of contributions from sources
other than the United States should take into account the
fiscal calendars of other major contributors; and
``(I) the Global Fund should not support activities
involving the `Affordable Medicines Facility-Malaria' or
similar entities pending compelling evidence of success from
pilot programs as evaluated by the Coordinator of United States
Government Activities to Combat Malaria Globally.''.
(b) Statement of Policy.--Section 202(b) of such Act is amended by
adding at the end the following:
``(3) Statement of policy.--The United States Government
regards the imposition by recipient countries of taxes or tariffs
on goods or services provided by the Global Fund, which are
supported through public and private donations, including the
substantial contribution of the American people, as inappropriate
and inconsistent with standards of good governance. The Global AIDS
Coordinator or other representatives of the United States
Government shall work with the Global Fund to dissuade governments
from imposing such duties, tariffs, or taxes.''.
(c) United States Financial Participation.--Section 202(d) of such
Act (22 U.S.C. 7622(d)) is amended--
(1) in paragraph (1)--
(A) by striking ``$1,000,000,000 for the period of fiscal
year 2004 beginning on January 1, 2004'' and inserting
``$2,000,000,000 for fiscal year 2009,''; and
(B) by striking ``the fiscal years 2005-2008'' and
inserting ``each of the fiscal years 2010 through 2013'';
(2) in paragraph (4)--
(A) in subparagraph (A)--
(i) in clause (i), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013'';
(ii) in clause (ii)--
(I) by striking ``during any of the fiscal years
2004 through 2008'' and inserting ``during any of the
fiscal years 2009 through 2013''; and
(II) by adding at the end the following: ``The
President may waive the application of this clause with
respect to assistance for Sudan that is overseen by the
Southern Country Coordinating Mechanism, including
Southern Sudan, Southern Kordofan, Blue Nile State, and
Abyei, if the President determines that the national
interest or humanitarian reasons justify such a waiver.
The President shall publish each waiver of this clause
in the Federal Register and, not later than 15 days
before the waiver takes effect, shall consult with the
Committee on Foreign Relations of the Senate and the
Committee on Foreign Affairs of the House of
Representatives regarding the proposed waiver.''; and
(iii) in clause (vi)--
(I) by striking ``for the purposes'' and inserting
``For the purposes'';
(II) by striking ``fiscal years 2004 through 2008''
and inserting ``fiscal years 2009 through 2013''; and
(III) by striking ``prior to fiscal year 2004'' and
inserting ``before fiscal year 2009'';
(B) in subparagraph (B)(iv), by striking ``fiscal years
2004 through 2008'' and inserting ``fiscal years 2009 through
2013''; and
(C) in subparagraph (C)(ii), by striking ``Committee on
International Relations'' and inserting ``Committee on Foreign
Affairs''; and
(3) by adding at the end the following:
``(5) Withholding funds.--Notwithstanding any other provision
of this Act, 20 percent of the amounts appropriated pursuant to
this Act for a contribution to support the Global Fund for each of
the fiscal years 2010 through 2013 shall be withheld from
obligation to the Global Fund until the Secretary of State
certifies to the appropriate congressional committees that the
Global Fund--
``(A) has established an evaluation framework for the
performance of Local Fund Agents (referred to in this paragraph
as `LFAs');
``(B) is undertaking a systematic assessment of the
performance of LFAs;
``(C) has adopted, and is implementing, a policy to publish
on a publicly available Web site--
``(i) grant performance reviews;
``(ii) all reports of the Inspector General of the
Global Fund, in a manner that is consistent with the Policy
for Disclosure of Reports of the Inspector General,
approved at the 16th Meeting of the Board of the Global
Fund;
``(iii) decision points of the Board of the Global
Fund;
``(iv) reports from Board committees to the Board; and
``(v) a regular collection and analysis of performance
data and funding of grants of the Global Fund, which shall
cover all principal recipients and all subrecipients;
``(D) is maintaining an independent, well-staffed Office of
the Inspector General that--
``(i) reports directly to the Board of the Global Fund;
and
``(ii) compiles regular, publicly published audits of
financial, programmatic, and reporting aspects of the
Global Fund, its grantees, and LFAs;
``(E) has established, and is reporting publicly on,
standard indicators for all program areas;
``(F) has established a methodology to track and is
publicly reporting on--
``(i) all subrecipients and the amount of funds
disbursed to each subrecipient on the grant's fiscal cycle;
and
``(ii) the distribution of resources, by grant and
principal recipient, for prevention, care, treatment, drugs
and commodities purchase, and other purposes;
``(G) has established a policy on tariffs imposed by
national governments on all goods and services financed by the
Global Fund;
``(H) through its Secretariat, has taken meaningful steps
to prevent national authorities in recipient countries from
imposing taxes or tariffs on goods or services provided by the
Fund;
``(I) is maintaining its status as a financing institution
focused on programs directly related to HIV/AIDS, malaria, and
tuberculosis;
``(J) is maintaining and making progress on--
``(i) sustaining its multisectoral approach, through
country coordinating mechanisms; and
``(ii) the implementation of grants, as reflected in
the proportion of resources allocated to different sectors,
including governments, civil society, and faith- and
community-based organizations; and
``(K) has established procedures providing access by the
Office of Inspector General of the Department of State and
Broadcasting Board of Governors, as cognizant Inspector
General, and the Inspector General of the Health and Human
Services and the Inspector General of the United States Agency
for International Development, to Global Fund financial data,
and other information relevant to United States contributions
(as determined by the Inspector General in consultation with
the Global AIDS Coordinator).
``(6) Summaries of board decisions and united states
positions.--Following each meeting of the Board of the Global Fund,
the Coordinator of United States Government Activities to Combat
HIV/AIDS Globally shall report on the public website of the
Coordinator a summary of Board decisions and how the United States
Government voted and its positions on such decisions.''.

b9c9ebd1211cf37140e5a59187fe202275dbd346a771722cadc4579058db8f98

HIV AND OTHER DISEASES.
(a) Sense of Congress.--Congress recognizes the need and urgency to
expand the range of interventions for preventing the transmission of
human immunodeficiency virus (HIV), including nonvaccine prevention
methods that can be controlled by women.
(b) NIH Office of AIDS Research.--Subpart 1 of part D of title
XXIII of the Public Health Service Act (42 U.S.C. 300cc-40 et seq.) is
amended by inserting after section 2351 the following:
``SEC. 2351A. MICROBICIDE RESEARCH.
``(a) Federal Strategic Plan.--The Director of the Office shall--
``(1) expedite the implementation of the Federal strategic
plans required by section 403(a) of the Public Health Service Act
(42 U.S.C. 283(a)(5)) regarding the conduct and support of research
on, and development of, a microbicide to prevent the transmission
of the human immunodeficiency virus; and
``(2) review and, as appropriate, revise such plan to
prioritize funding and activities relative to their scientific
urgency and potential market readiness.
``(b) Coordination.--In implementing, reviewing, and prioritizing
elements of the plan described in subsection (a), the Director of the
Office shall consult, as appropriate, with--
``(1) representatives of other Federal agencies involved in
microbicide research, including the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, the Director of
the Centers for Disease Control and Prevention, and the
Administrator of the United States Agency for International
Development;
``(2) the microbicide research and development community; and
``(3) health advocates.''.
(c) National Institute of Allergy and Infectious Diseases.--Subpart
6 of part C of title IV of the Public Health Service Act (42 U.S.C.
285f et seq.) is amended by adding at the end the following:
``SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT.
``The Director of the Institute, acting through the head of the
Division of AIDS, shall, consistent with the peer-review process of the
National Institutes of Health, carry out research on, and development
of, safe and effective methods for use by women to prevent the
transmission of the human immunodeficiency virus, which may include
microbicides.''.
(d) CDC.--Part B of title III of the Public Health Service Act (42
U.S.C. 243 et seq.) is amended by inserting after section 317S the
following:
``SEC. 317T. MICROBICIDE RESEARCH.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention is strongly encouraged to fully implement the Centers'
microbicide agenda to support research and development of microbicides
for use to prevent the transmission of the human immunodeficiency
virus.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for each of fiscal years
2009 through 2013 to carry out this section.''.
(e) United States Agency for International Development.--
(1) In general.--The Administrator of the United States Agency
for International Development, in coordination with the Coordinator
of United States Government Activities to Combat HIV/AIDS Globally,
may facilitate availability and accessibility of microbicides,
provided that such pharmaceuticals are approved, tentatively
approved, or otherwise authorized for use by--
(A) the Food and Drug Administration;
(B) a stringent regulatory agency acceptable to the
Secretary of Health and Human Services; or
(C) a quality assurance mechanism acceptable to the
Secretary of Health and Human Services.
(2) Authorization of appropriations.--Of the amounts authorized
to be appropriated under section 401 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(22 U.S.C. 7671) for HIV/AIDS assistance, there are authorized to
be appropriated to the President such sums as may be necessary for
each of the fiscal years 2009 through 2013 to carry out this
subsection.

29cbaa7f1f88b6110254f66be041efa28920ec219f4d10939d915d8e044aff34

STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF PARTNER
COUNTRIES.
(a) In General.--Title II of the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621) is
amended by adding at the end the following:
``SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY
STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF PARTNER
COUNTRIES.
``(a) Statement of Policy.--It shall be the policy of the United
States Government--
``(1) to invest appropriate resources authorized under this
Act--
``(A) to carry out activities to strengthen HIV/AIDS,
tuberculosis, and malaria health policies and health systems;
and
``(B) to provide workforce training and capacity-building
consistent with the goals and objectives of this Act; and
``(2) to support the development of a sound policy environment
in partner countries to increase the ability of such countries--
``(A) to maximize utilization of health care resources from
donor countries;
``(B) to increase national investments in health and
education and maximize the effectiveness of such investments;
``(C) to improve national HIV/AIDS, tuberculosis, and
malaria strategies;
``(D) to deliver evidence-based services in an effective
and efficient manner; and
``(E) to reduce barriers that prevent recipients of
services from achieving maximum benefit from such services.
``(b) Assistance To Improve Public Finance Management Systems.--
``(1) In general.--Consistent with the authority under section
129 of the Foreign Assistance Act of 1961 (22 U.S.C. 2152), the
Secretary of the Treasury, acting through the head of the Office of
Technical Assistance, is authorized to provide assistance for
advisors and partner country finance, health, and other relevant
ministries to improve the effectiveness of public finance
management systems in partner countries to enable such countries to
receive funding to carry out programs to combat HIV/AIDS,
tuberculosis, and malaria and to manage such programs.
``(2) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401 for HIV/AIDS
assistance, there are authorized to be appropriated to the
Secretary of the Treasury such sums as may be necessary for each of
the fiscal years 2009 through 2013 to carry out this subsection.
``(c) Plan Required.--The Global AIDS Coordinator, in collaboration
with the Administrator of the United States Agency for International
Development (USAID), shall develop and implement a plan to combat HIV/
AIDS by strengthening health policies and health systems of partner
countries as part of USAID's `Health Systems 2020' project. Recognizing
that human and institutional capacity form the core of any health care
system that can sustain the fight against HIV/AIDS, tuberculosis, and
malaria, the plan shall include a strategy to encourage postsecondary
educational institutions in partner countries, particularly in Africa,
in collaboration with United States postsecondary educational
institutions, including historically black colleges and universities,
to develop such human and institutional capacity and in the process
further build their capacity to sustain the fight against these
diseases.''.
(b) Clerical Amendment.--The table of contents for the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7601 note) is amended by inserting after the item
relating to section 203, as added by section 203 of this Act, the
following:
``Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by
strengthening health policies and health systems of partner
countries.''.

7530ca3e8b12dab5071652d2b1c1fcdc677e7c6fee6f917d8f55b627f96d20fe

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

12d84c39ba6f081cdeeabd3a05710e864cf4ff972e9926419f4d043c1c66ee0a

(a) Technical Assistance for Developing Countries.--The
Administrator of the United States Agency for International
Development, utilizing public-private partners, as appropriate, and
working in coordination with other international development agencies,
is authorized to strengthen the capacity of developing countries'
governmental institutions to--
(1) collect evidence for informed decision-making and
introduction of new vaccines, including potential HIV/AIDS,
tuberculosis, and malaria vaccines, if such vaccines are determined
to be safe and effective;
(2) review protocols for clinical trials and impact studies and
improve the implementation of clinical trials; and
(3) ensure adequate supply chain and delivery systems.
(b) Advanced Market Commitments.--
(1) Purpose.--The purpose of this subsection is to improve
global health by requiring the United States to participate in
negotiations for advance market commitments for the development of
future vaccines, including potential vaccines for HIV/AIDS,
tuberculosis, and malaria.
(2) Negotiation requirement.--The Secretary of the Treasury
shall enter into negotiations with the appropriate officials of the
International Bank of Reconstruction and Development (World Bank)
and the GAVI Alliance, the member nations of such entities, and
other interested parties to establish advanced market commitments
to purchase vaccines to combat HIV/AIDS, tuberculosis, malaria, and
other related infectious diseases.
(3) Requirements.--In negotiating the United States
participation in programs for advanced market commitments, the
Secretary of the Treasury shall take into account whether programs
for advance market commitments include--
(A) legally binding contracts for product purchase that
include a fair market price for up to a maximum number of
treatments, creating a strong market incentive;
(B) clearly defined and transparent rules of program
participation for qualified developers and suppliers of the
product;
(C) clearly defined requirements for eligible vaccines to
ensure that they are safe and effective and can be delivered in
developing country contexts;
(D) dispute settlement mechanisms; and
(E) sufficient flexibility to enable the contracts to be
adjusted in accord with new information related to projected
market size and other factors while still maintaining the
purchase commitment at a fair price.
(4) Report.--Not later than 1 year after the date of the
enactment of this Act--
(A) the Secretary of the Treasury shall submit a report to
the appropriate congressional committees on the status of the
United States negotiations to participate in programs for the
advanced market commitments under this subsection; and
(B) the President shall produce a comprehensive report,
written by a study group of qualified professionals from
relevant Federal agencies and initiatives, nongovernmental
organizations, and industry representatives, that sets forth a
coordinated strategy to accelerate development of vaccines for
infectious diseases, such as HIV/AIDS, malaria, and
tuberculosis, which includes--
(i) initiatives to create economic incentives for the
research, development, and manufacturing of vaccines for
HIV/AIDS, tuberculosis, malaria, and other infectious
diseases;
(ii) an expansion of public-private partnerships and
the leveraging of resources from other countries and the
private sector; and
(iii) efforts to maximize United States capabilities to
support clinical trials of vaccines in developing countries
and to address the challenges of delivering vaccines in
developing countries to minimize delays in access once
vaccines are available.
Subtitle A--General Assistance and Programs

1382f2c5b757002fd21636396f5d5e8e273ea17abeeac5ab0e5b6d78572ccdd8

c6c251b2232904473ddf9de9172385c2358bd0be0c6fc3664a7062187785368c

(a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to control tuberculosis. In all countries
in which the Government of the United States has established
development programs, particularly in countries with the highest burden
of tuberculosis and other countries with high rates of tuberculosis,
the United States should support the objectives of the Global Plan to
Stop TB, including through achievement of the following goals:
``(1) Reduce by half the tuberculosis death and disease burden
from the 1990 baseline.
``(2) Sustain or exceed the detection of at least 70 percent of
sputum smear-positive cases of tuberculosis and the successful
treatment of at least 85 percent of the cases detected in countries
with established United States Agency for International Development
tuberculosis programs.
``(3) In support of the Global Plan to Stop TB, the President
shall establish a comprehensive, 5-year United States strategy to
expand and improve United States efforts to combat tuberculosis
globally, including a plan to support--
``(A) the successful treatment of 4,500,000 new sputum
smear tuberculosis patients under DOTS programs by 2013,
primarily through direct support for needed services,
commodities, health workers, and training, and additional
treatment through coordinated multilateral efforts; and
``(B) the diagnosis and treatment of 90,000 new multiple
drug resistant tuberculosis cases by 2013, and additional
treatment through coordinated multilateral efforts.''.
(b) Priority To Stop TB Strategy.--Section 104B(e) of such Act is
amended to read as follows:
``(e) Priority To Stop TB Strategy.--In furnishing assistance under
subsection (c), the President shall give priority to--
``(1) direct services described in the Stop TB Strategy,
including expansion and enhancement of Directly Observed Treatment
Short-course (DOTS) coverage, rapid testing, treatment for
individuals infected with both tuberculosis and HIV, and treatment
for individuals with multi-drug resistant tuberculosis (MDR-TB),
strengthening of health systems, use of the International Standards
for Tuberculosis Care by all providers, empowering individuals with
tuberculosis, and enabling and promoting research to develop new
diagnostics, drugs, and vaccines, and program-based operational
research relating to tuberculosis; and
``(2) funding for the Global Tuberculosis Drug Facility, the
Stop Tuberculosis Partnership, and the Global Alliance for TB Drug
Development.''.
(c) Assistance for the World Health Organization and the Stop
Tuberculosis Partnership.--Section 104B of such Act is amended--
(1) by redesignating subsection (f) as subsection (h); and
(2) by inserting after subsection (e) the following:
``(f) Assistance for the World Health Organization and the Stop
Tuberculosis Partnership.--In carrying out this section, the President,
acting through the Administrator of the United States Agency for
International Development, is authorized to provide increased resources
to the World Health Organization and the Stop Tuberculosis Partnership
to improve the capacity of countries with high rates of tuberculosis
and other affected countries to implement the Stop TB Strategy and
specific strategies related to addressing multiple drug resistant
tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-
TB).''.
(d) Annual Report.--Section 104B of such Act is amended by
inserting after subsection (f), as added by subsection (c) of this
section, the following:
``(g) Annual Report.--The President shall submit an annual report
to Congress that describes the impact of United States foreign
assistance on efforts to control tuberculosis, including--
``(1) the number of tuberculosis cases diagnosed and the number
of cases cured in countries receiving United States bilateral
foreign assistance for tuberculosis control purposes;
``(2) a description of activities supported with United States
tuberculosis resources in each country, including a description of
how those activities specifically contribute to increasing the
number of people diagnosed and treated for tuberculosis;
``(3) in each country receiving bilateral United States foreign
assistance for tuberculosis control purposes, the percentage
provided for direct tuberculosis services in countries receiving
United States bilateral foreign assistance for tuberculosis control
purposes;
``(4) a description of research efforts and clinical trials to
develop new tools to combat tuberculosis, including diagnostics,
drugs, and vaccines supported by United States bilateral
assistance;
``(5) the number of persons who have been diagnosed and started
treatment for multidrug-resistant tuberculosis in countries
receiving United States bilateral foreign assistance for
tuberculosis control programs;
``(6) a description of the collaboration and coordination of
United States anti-tuberculosis efforts with the World Health
Organization, the Global Fund, and other major public and private
entities within the Stop TB Strategy;
``(7) the constraints on implementation of programs posed by
health workforce shortages and capacities;
``(8) the number of people trained in tuberculosis control; and
``(9) a breakdown of expenditures for direct patient
tuberculosis services, drugs and other commodities, drug
management, training in diagnosis and treatment, health systems
strengthening, research, and support costs.''.
(e) Definitions.--Section 104B(h) of such Act, as redesignated by
subsection (c), is amended--
(1) in paragraph (1), by striking the period at the end and
inserting the following: ``including--
``(A) low-cost and effective diagnosis, treatment, and
monitoring of tuberculosis;
``(B) a reliable drug supply;
``(C) a management strategy for public health systems;
``(D) health system strengthening;
``(E) promotion of the use of the International Standards
for Tuberculosis Care by all care providers;
``(F) bacteriology under an external quality assessment
framework;
``(G) short-course chemotherapy; and
``(H) sound reporting and recording systems.''; and
(2) by redesignating paragraph (5) as paragraph (6); and
(3) by inserting after paragraph (4) the following:
``(5) Stop tb strategy.--The term `Stop TB Strategy' means the
6-point strategy to reduce tuberculosis developed by the World
Health Organization, which is described in the Global Plan to Stop
TB 2006-2015: Actions for Life, a comprehensive plan developed by
the Stop TB Partnership that sets out the actions necessary to
achieve the millennium development goal of cutting tuberculosis
deaths and disease burden in half by 2015.''.
(f) Authorization of Appropriations.--Section 302 (b) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7632(b)) is amended--
(1) in paragraph (1), by striking ``such sums as may be
necessary for each of the fiscal years 2004 through 2008'' and
inserting ``a total of $4,000,000,000 for the 5-year period
beginning on October 1, 2008.''; and
(2) in paragraph (3), by striking ``fiscal years 2004 through
2008'' and inserting ``fiscal years 2009 through 2013.''.

bc88e1fa40d618d20733341dee8e8ce9c1be85ad3db45c4a96f790b121675ed1

(a) Amendment to the Foreign Assistance Act of 1961.--Section
104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-4(b)) is
amended by inserting ``treatment,'' after ``control,''.
(b) Authorization of Appropriations.--Section 303 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
(1) in subsection (b)--
(A) in paragraph (1), by striking ``such sums as may be
necessary for fiscal years 2004 through 2008'' and inserting
``$5,000,000,000 during the 5-year period beginning on October
1, 2008''; and
(B) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''; and
(2) by adding at the end the following:
``(c) Statement of Policy.--Providing assistance for the
prevention, control, treatment, and the ultimate eradication of malaria
is--
``(1) a major objective of the foreign assistance program of
the United States; and
``(2) 1 component of a comprehensive United States global
health strategy to reduce disease burdens and strengthen
communities around the world.
``(d) Development of a Comprehensive 5-Year Strategy.--The
President shall establish a comprehensive, 5-year strategy to combat
global malaria that--
``(1) strengthens the capacity of the United States to be an
effective leader of international efforts to reduce malaria burden;
``(2) maintains sufficient flexibility and remains responsive
to the ever-changing nature of the global malaria challenge;
``(3) includes specific objectives and multisectoral approaches
and strategies to reduce the prevalence, mortality, incidence, and
spread of malaria;
``(4) describes how this strategy would contribute to the
United States' overall global health and development goals;
``(5) clearly explains how outlined activities will interact
with other United States Government global health activities,
including the 5-year global AIDS strategy required under this Act;
``(6) expands public-private partnerships and leverage of
resources;
``(7) coordinates among relevant Federal agencies to maximize
human and financial resources and to reduce duplication among these
agencies, foreign governments, and international organizations;
``(8) coordinates with other international entities, including
the Global Fund;
``(9) maximizes United States capabilities in the areas of
technical assistance and training and research, including vaccine
research; and
``(10) establishes priorities and selection criteria for the
distribution of resources based on factors such as--
``(A) the size and demographics of the population with
malaria;
``(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.''.

307ec999e87c9e2b67abb6593c5f4f622b9ef98eff5770e4c429035d6443af7c

Section 304 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended to
read as follows:
``SEC. 304. MALARIA RESPONSE COORDINATOR.
``(a) In General.--There is established within the United States
Agency for International Development a Coordinator of United States
Government Activities to Combat Malaria Globally (referred to in this
section as the `Malaria Coordinator'), who shall be appointed by the
President.
``(b) Authorities.--The Malaria Coordinator, acting through
nongovernmental organizations (including faith-based and community-
based organizations), partner country finance, health, and other
relevant ministries, and relevant executive branch agencies as may be
necessary and appropriate to carry out this section, is authorized to--
``(1) operate internationally to carry out prevention, care,
treatment, support, capacity development, and other activities to
reduce the prevalence, mortality, and incidence of malaria;
``(2) provide grants to, and enter into contracts and
cooperative agreements with, nongovernmental organizations
(including faith-based organizations) to carry out this section;
and
``(3) transfer and allocate executive branch agency funds that
have been appropriated for the purposes described in paragraphs (1)
and (2).
``(c) Duties.--
``(1) In general.--The Malaria Coordinator has primary
responsibility for the oversight and coordination of all resources
and international activities of the United States Government
relating to efforts to combat malaria.
``(2) Specific duties.--The Malaria Coordinator shall--
``(A) facilitate program and policy coordination of
antimalarial efforts among relevant executive branch agencies
and nongovernmental organizations by auditing, monitoring, and
evaluating such programs;
``(B) ensure that each relevant executive branch agency
undertakes antimalarial programs primarily in those areas in
which the agency has the greatest expertise, technical
capability, and potential for success;
``(C) coordinate relevant executive branch agency
activities in the field of malaria prevention and treatment;
``(D) coordinate planning, implementation, and evaluation
with the Global AIDS Coordinator in countries in which both
programs have a significant presence;
``(E) coordinate with national governments, international
agencies, civil society, and the private sector; and
``(F) establish due diligence criteria for all recipients
of funds appropriated by the Federal Government for malaria
assistance.
``(d) Assistance for the World Health Organization.--In carrying
out this section, the President may provide financial assistance to the
Roll Back Malaria Partnership of the World Health Organization to
improve the capacity of countries with high rates of malaria and other
affected countries to implement comprehensive malaria control programs.
``(e) Coordination of Assistance Efforts.--In carrying out this
section and in accordance with section 104C of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator shall
coordinate the provision of assistance by working with--
``(1) relevant executive branch agencies, including--
``(A) the Department of State (including the Office of the
Global AIDS Coordinator);
``(B) the Department of Health and Human Services;
``(C) the Department of Defense; and
``(D) the Office of the United States Trade Representative;
``(2) relevant multilateral institutions, including--
``(A) the World Health Organization;
``(B) the United Nations Children's Fund;
``(C) the United Nations Development Programme;
``(D) the Global Fund;
``(E) the World Bank; and
``(F) the Roll Back Malaria Partnership;
``(3) program delivery and efforts to lift barriers that would
impede effective and comprehensive malaria control programs; and
``(4) partner or recipient country governments and national
entities including universities and civil society organizations
(including faith- and community-based organizations).
``(f) Research.--To carry out this section, the Malaria
Coordinator, in accordance with section 104C of the Foreign Assistance
Act of 1961 (22 U.S.C. 1151d-4), shall ensure that operations and
implementation research conducted under this Act will closely
complement the clinical and program research being undertaken by the
National Institutes of Health. The Centers for Disease Control and
Prevention should advise the Malaria Coordinator on priorities for
operations and implementation research and should be a key implementer
of this research.
``(g) Monitoring.--To ensure that adequate malaria controls are
established and implemented, the Centers for Disease Control and
Prevention should advise the Malaria Coordinator on monitoring,
surveillance, and evaluation activities and be a key implementer of
such activities under this Act. Such activities shall complement,
rather than duplicate, the work of the World Health Organization.
``(h) Annual Report.--
``(1) Submission.--Not later than 1 year after the date of the
enactment of the Tom Lantos and Henry J. Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter, the President
shall submit a report to the appropriate congressional committees
that describes United States assistance for the prevention,
treatment, control, and elimination of malaria.
``(2) Contents.--The report required under paragraph (1) shall
describe--
``(A) the countries and activities to which malaria
resources have been allocated;
``(B) the number of people reached through malaria
assistance programs, including data on children and pregnant
women;
``(C) research efforts to develop new tools to combat
malaria, including drugs and vaccines;
``(D) the collaboration and coordination of United States
antimalarial efforts with the World Health Organization, the
Global Fund, the World Bank, other donor governments, major
private efforts, and relevant executive agencies;
``(E) the coordination of United States antimalarial
efforts with the national malarial strategies of other donor or
partner governments and major private initiatives;
``(F) the estimated impact of United States assistance on
childhood mortality and morbidity from malaria;
``(G) the coordination of antimalarial efforts with broader
health and development programs; and
``(H) the constraints on implementation of programs posed
by health workforce shortages or capacities; and
``(I) the number of personnel trained as health workers and
the training levels achieved.''.

d969d1004f534e812eea427062c613bd2964e508e70b94bf3dd672e1c9227eca

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.

0df81d2f671ae2b666f876b18b6113e2261db6f0b3b94f38756e9625c0d84de2

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''.

3038cf614bf62f7191c58168aa326233a7bd1fd9caf92a602f7962b9d8322beb

Section 312(b) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is amended by
striking paragraphs (1), (2), and (3) and inserting the following:
``(1) establish a target for the prevention and treatment of
mother-to-child transmission of HIV that, by 2013, will reach at
least 80 percent of pregnant women in those countries most affected
by HIV/AIDS in which the United States has HIV/AIDS programs;
``(2) establish a target that, by 2013, the proportion of
children receiving care and treatment under this Act is
proportionate to their numbers within the population of HIV
infected individuals in each country;
``(3) integrate care and treatment with prevention of mother-
to-child transmission of HIV programs to improve outcomes for HIV-
affected women and families as soon as is feasible and support
strategies that promote successful follow-up and continuity of care
of mother and child;
``(4) expand programs designed to care for children orphaned
by, affected by, or vulnerable to HIV/AIDS;
``(5) ensure that women in prevention of mother-to-child
transmission of HIV programs are provided with, or referred to,
appropriate maternal and child services; and
``(6) develop a timeline for expanding access to more effective
regimes to prevent mother-to-child transmission of HIV, consistent
with the national policies of countries in which programs are
administered under this Act and the goal of achieving universal use
of such regimes as soon as possible.''.

a8e43603697bbb91dc03f01c3acb15429545784c8bb725380e9d02c7251fdb37

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''.

3fccc8ea0e4e8b362f7af62d12c4ea2ad8d26bd611d92f337dd6cc788861e24d

Section 312 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) is amended by
adding at the end the following:
``(c) Prevention of Mother-to-Child Transmission Expert Panel.--
``(1) Establishment.--The Global AIDS Coordinator shall
establish a panel of experts to be known as the Prevention of
Mother-to-Child Transmission Panel (referred to in this subsection
as the `Panel') to--
``(A) provide an objective review of activities to prevent
mother-to-child transmission of HIV; and
``(B) provide recommendations to the Global AIDS
Coordinator and to the appropriate congressional committees for
scale-up of mother-to-child transmission prevention services
under this Act in order to achieve the target established in
subsection (b)(1).
``(2) Membership.--The Panel shall be convened and chaired by
the Global AIDS Coordinator, who shall serve as a nonvoting member.
The Panel shall consist of not more than 15 members (excluding the
Global AIDS Coordinator), to be appointed by the Global AIDS
Coordinator not later than 1 year after the date of the enactment
of this Act, including--
``(A) 2 members from the Department of Health and Human
Services with expertise relating to the prevention of mother-
to-child transmission activities;
``(B) 2 members from the United States Agency for
International Development with expertise relating to the
prevention of mother-to-child transmission activities;
``(C) 2 representatives from among health ministers of
national governments of foreign countries in which programs
under this Act are administered;
``(D) 3 members representing organizations implementing
prevention of mother-to-child transmission activities under
this Act;
``(E) 2 health care researchers with expertise relating to
global HIV/AIDS activities; and
``(F) representatives from among patient advocate groups,
health care professionals, persons living with HIV/AIDS, and
non-governmental organizations with expertise relating to the
prevention of mother-to-child transmission activities, giving
priority to individuals in foreign countries in which programs
under this Act are administered.
``(3) Duties of panel.--The Panel shall--
``(A) assess the effectiveness of current activities in
reaching the target described in subsection (b)(1);
``(B) review scientific evidence related to the provision
of mother-to-child transmission prevention services, including
programmatic data and data from clinical trials;
``(C) review and assess ways in which the Office of the
United States Global AIDS Coordinator collaborates with
international and multilateral entities on efforts to prevent
mother-to-child transmission of HIV in affected countries;
``(D) identify barriers and challenges to increasing access
to mother-to-child transmission prevention services and
evaluate potential mechanisms to alleviate those barriers and
challenges;
``(E) identify the extent to which stigma has hindered
pregnant women from obtaining HIV counseling and testing or
returning for results, and provide recommendations to address
such stigma and its effects;
``(F) identify opportunities to improve linkages between
mother-to-child transmission prevention services and care and
treatment programs; and
``(G) recommend specific activities to facilitate reaching
the target described in subsection (b)(1).
``(4) Report.--
``(A) In general.--Not later than 1 year after the date on
which the Panel is first convened, the Panel shall submit a
report containing a detailed statement of the recommendations,
findings, and conclusions of the Panel to the appropriate
congressional committees.
``(B) Availability.--The report submitted under
subparagraph (A) shall be made available to the public.
``(C) Consideration by coordinator.--The Coordinator
shall--
``(i) consider any recommendations contained in the
report submitted under subparagraph (A); and
``(ii) include in the annual report required under
section 104A(f) of the Foreign Assistance Act of 1961 a
description of the activities conducted in response to the
recommendations made by the Panel and an explanation of any
recommendations not implemented at the time of the report.
``(5) Authorization of appropriations.--There are authorized to
be appropriated to the Panel such sums as may be necessary for each
of the fiscal years 2009 through 2011 to carry out this section.
``(6) Termination.--The Panel shall terminate on the date that
is 60 days after the date on which the Panel submits the report to
the appropriate congressional committees under paragraph (4).''.

facbcb4ae9dd79c82a23f685672cb9aa2b606e123957e6acb1f5dea817f768e8

(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.

a718f9a2d9f9f77b405fc79191068ecc2346829e7451583371ee517f7095631a

TITLE IV

-FUNDING ALLOCATIONS

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''.

d0e8d707a6338e895267f9378fc6b92d43a45a02dcad33c1f95c081aa8bbba14

Section 403 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is amended--
(1) by amending subsection (a) to read as follows:
``(a) Balanced Funding Requirement.--
``(1) In general.--The Global AIDS Coordinator shall--
``(A) provide balanced funding for prevention activities
for sexual transmission of HIV/AIDS; and
``(B) ensure that activities promoting abstinence, delay of
sexual debut, monogamy, fidelity, and partner reduction are
implemented and funded in a meaningful and equitable way in the
strategy for each host country based on objective
epidemiological evidence as to the source of infections and in
consultation with the government of each host county involved
in HIV/AIDS prevention activities.
``(2) Prevention strategy.--
``(A) Establishment.--In carrying out paragraph (1), the
Global AIDS Coordinator shall establish an HIV sexual
transmission prevention strategy governing the expenditure of
funds authorized under this Act to prevent the sexual
transmission of HIV in any host country with a generalized
epidemic.
``(B) Report.--In each host country described in
subparagraph (A), if the strategy established under
subparagraph (A) provides less than 50 percent of the funds
described in subparagraph (A) for activities promoting
abstinence, delay of sexual debut, monogamy, fidelity, and
partner reduction, the Global AIDS Coordinator shall, not later
than 30 days after the issuance of this strategy, report to the
appropriate congressional committees on the justification for
this decision.
``(3) Exclusion.--Programs and activities that implement or
purchase new prevention technologies or modalities, such as medical
male circumcision, public education about risks to acquire HIV
infection from blood exposures, promoting universal precautions,
investigating suspected nosocomial infections, pre-exposure
pharmaceutical prophylaxis to prevent transmission of HIV, or
microbicides and programs and activities that provide counseling
and testing for HIV or prevent mother-to-child prevention of HIV,
shall not be included in determining compliance with paragraph (2).
``(4) Report.--Not later than 1 year after the date of the
enactment of the Tom Lantos and Henry J. Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter as part of the
annual report required under section 104A(e) of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the President
shall--
``(A) submit a report on the implementation of paragraph
(2) for the most recently concluded fiscal year to the
appropriate congressional committees; and
``(B) make the report described in subparagraph (A)
available to the public.'';
(2) in subsection (b)--
(A) by striking ``fiscal years 2006 through 2008'' and
inserting ``fiscal years 2009 through 2013''; and
(B) by striking ``vulnerable children affected by'' and
inserting ``other children affected by, or vulnerable to,'';
and
(3) by adding at the end the following:
``(c) Funding Allocation.--For each of the fiscal years 2009
through 2013, more than half of the amounts appropriated for bilateral
global HIV/AIDS assistance pursuant to section 401 shall be expended
for--
``(1) antiretroviral treatment for HIV/AIDS;
``(2) clinical monitoring of HIV-seropositive people not in
need of antiretroviral treatment;
``(3) care for associated opportunistic infections;
``(4) nutrition and food support for people living with HIV/
AIDS; and
``(5) other essential HIV/AIDS-related medical care for people
living with HIV/AIDS.
``(d) Treatment, Prevention, and Care Goals.--For each of the
fiscal years 2009 through 2013--
``(1) the treatment goal under section 402(a)(3) shall be
increased above 2,000,000 by at least the percentage increase in
the amount appropriated for bilateral global HIV/AIDS assistance
for such fiscal year compared with fiscal year 2008;
``(2) any increase in the treatment goal under section
402(a)(3) above the percentage increase in the amount appropriated
for bilateral global HIV/AIDS assistance for such fiscal year
compared with fiscal year 2008 shall be based on long-term
requirements, epidemiological evidence, the share of treatment
needs being met by partner governments and other sources of
treatment funding, and other appropriate factors;
``(3) the treatment goal under section 402(a)(3) shall be
increased above the number calculated under paragraph (1) by the
same percentage that the average United States Government cost per
patient of providing treatment in countries receiving bilateral
HIV/AIDS assistance has decreased compared with fiscal year 2008;
and
``(4) the prevention and care goals established in clauses (i)
and (iv) of section 104A(b)(1)(A) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b-2(b)(1)(A)) shall be increased consistent
with epidemiological evidence and available resources.''.

397af7898d2ea3aa3adc60a2738f93e4904c7e249184e60ea1813105cde6feb7

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

94bc9c6810e5b9d53a8f2b2da15f358392998929e9c1c6d9f628ddb43704d20b

TITLE V

-MISCELLANEOUS

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

0f8847088abf64a9eaa1c5cb5af6427e6a1d0448003395787ab387dcf15d186c

Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 — HR. 5501

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