\ publaw \ Pub. L. 110-293 Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008
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Pub. L. 110-293
Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008
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
,
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'.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 305.
Amendment to Immigration and Nationality Act.
Sec. 308.
Annual report on prevention of mother-to-child transmission of HIV.
Sec. 309.
Prevention of mother-to-child transmission expert panel.
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:
`(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;
`(I) the increase in the number of individuals with HIV/AIDS receiving antiretroviral treatment above the goal established under section 402(a)(3) and increased pursuant to paragraphs (1) through (3) of section 403(d); and
`(II) additional treatment through coordinated multilateral efforts;
`(iii) support care for 12,000,000 individuals infected with or affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children affected by HIV/AIDS, with an emphasis on promoting a comprehensive, coordinated system of services to be integrated throughout the continuum of care;
`(iv) provide at least 80 percent of the target population with access to counseling, testing, and treatment to prevent the transmission of HIV from mother-to-child;
`(v) provide care and treatment services to children with HIV in proportion to their percentage within the HIV-infected population of a given partner country; and
`(vi) train and support retention of health care professionals, paraprofessionals, and community health workers in HIV/AIDS prevention, treatment, and care, with the target of providing such training to at least 140,000 new health care professionals and paraprofessionals with an emphasis on training and in country deployment of critically needed doctors and nurses;
`(B) strengthen the capacity to deliver primary health care in developing countries, especially in sub-Saharan Africa;
`(C) support and help countries in their efforts to achieve staffing levels of at least 2.3 doctors, nurses, and midwives per 1,000 population, as called for by the World Health Organization; and
`(D) help partner countries to develop independent, sustainable HIV/AIDS programs.
`(2) COORDINATED GLOBAL STRATEGY- The United States and other countries with the sufficient capacity should provide assistance to countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, and Latin America, and other countries and regions confronting HIV/AIDS epidemics in a coordinated global strategy to help address generalized and concentrated epidemics through HIV/AIDS prevention, treatment, care, monitoring and evaluation, and related activities.
`(3) PRIORITIES- The United States Government's response to the global HIV/AIDS pandemic and the Government's efforts to help countries assume leadership of sustainable campaigns to combat their local epidemics should place high priority on--
`(A) the prevention of the transmission of HIV;
`(B) moving toward universal access to HIV/AIDS prevention counseling and services;
`(C) the inclusion of cost sharing assurances that meet the requirements under section 110; and
`(D) the inclusion of transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, or budget support by respective foreign governments.'.
(b) Authorization- Section 104A(c) of such Act is amended--
(1) in paragraph (1), by striking `and other countries and areas.' and inserting `Central Asia, Eastern Europe, Latin America, and other countries and areas, particularly with respect to refugee populations or those in postconflict settings in such countries and areas with significant or increasing HIV incidence rates.';
(2) in paragraph (2), by striking `and other countries and areas affected by the HIV/AIDS pandemic' and inserting `Central Asia, Eastern Europe, Latin America, and other countries and areas affected by the HIV/AIDS pandemic, particularly with respect to refugee populations or those in post-conflict settings in such countries and areas with significant or increasing HIV incidence rates.'; and
(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--
(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:
`(i) achieve the goal of reaching 80 percent of pregnant women for prevention and treatment of mother-to-child transmission of HIV in countries in which the United States is implementing HIV/AIDS programs by 2013; and
`(ii) promote infant feeding options and treatment protocols that meet the most recent criteria established by the World Health Organization;
`(G) medical male circumcision programs as part of national strategies to combat the transmission of HIV/AIDS;';
(F) in subparagraph (I), as redesignated, by striking `and' at the end; and
(G) by adding at the end the following:
`(K) assistance for counseling, testing, treatment, care, and support programs, including--
`(i) counseling and other services for the prevention of reinfection of individuals with HIV/AIDS;
`(ii) counseling to prevent sexual transmission of HIV, including--
`(I) life skills development for practicing abstinence and faithfulness;
`(II) reducing the number of sexual partners;
`(III) delaying sexual debut; and
`(IV) ensuring correct and consistent use of condoms;
`(iii) assistance to engage underlying vulnerabilities to HIV/AIDS, especially those of women and girls;
`(iv) assistance for appropriate HIV/AIDS education programs and training targeted to prevent the transmission of HIV among men who have sex with men;
`(v) assistance to provide male and female condoms;
`(vi) diagnosis and treatment of other sexually transmitted infections;
`(vii) strategies to address the stigma and discrimination that impede HIV/AIDS prevention efforts; and
`(viii) assistance to facilitate widespread access to microbicides for HIV prevention, if safe and effective products become available, including financial and technical support for culturally appropriate introductory programs, procurement, distribution, logistics management, program delivery, acceptability studies, provider training, demand generation, and postintroduction monitoring.'; and
(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;';
(A) in subparagraph (C), by striking `and' at the end;
(B) in subparagraph (D), by striking the period at the end and inserting a semicolon; and
(C) by adding at the end the following:
`(E) carrying out and expanding program monitoring, impact evaluation research and analysis, and operations research and disseminating data and findings through mechanisms to be developed by the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, in coordination with the Director of the Centers for Disease Control, in order to--
`(i) improve accountability, increase transparency, and ensure the delivery of evidence-based services through the collection, evaluation, and analysis of data regarding gender-responsive interventions, disaggregated by age and sex;
`(ii) identify and replicate effective models; and
`(iii) develop gender indicators to measure outcomes and the impacts of interventions; and
`(F) establishing appropriate systems to--
`(i) gather epidemiological and social science data on HIV; and
`(ii) evaluate the effectiveness of prevention efforts among men who have sex with men, with due consideration to stigma and risks associated with disclosure.';
(A) by redesignating subparagraph (C) as subparagraph (D); and
(B) by inserting after subparagraph (B) the
`(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.';
(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
`(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
`(i) improve the effectiveness of national responses to HIV/AIDS;
`(ii) strengthen overall health systems in high-prevalence countries, including support for workforce training, retention, and effective deployment, capacity building, laboratory development, equipment maintenance and repair, and public health and related public financial management systems and operations; and
`(iii) encourage fair and transparent procurement practices among partner countries; and
`(iv) promote in-country or intra-regional pediatric training for physicians and other health professionals, preferably through public-private partnerships involving colleges and universities, with the goal of increasing pediatric HIV workforce capacity.'; and
(6) by adding at the end the following:
`(8) COMPACTS AND FRAMEWORK AGREEMENTS- The development of compacts or framework agreements, tailored to local circumstances, with national governments or regional partnerships in countries with significant HIV/AIDS burdens to promote host government commitment to deeper integration of HIV/AIDS services into health systems, contribute to health systems overall, and enhance sustainability, including--
`(A) cost sharing assurances that meet the requirements under section 110; and
`(B) transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, or budget support by respective foreign governments.'.
(d) Compacts and Framework Agreements- Section 104A of such
(1) by redesignating subsections (e) through (g) as subsections (f) through (h); and
(2) by inserting after subsection (d) the following:
`(e) Compacts and Framework Agreements-
`(1) FINDINGS- Congress makes the following findings:
`(A) The congressionally mandated Institute of Medicine report entitled `PEPFAR Implementation: Progress and Promise' states: `The next strategy [of the U.S. Global AIDS Initiative] should squarely address the needs and challenges involved in supporting sustainable country HIV/AIDS programs, thereby transitioning from a focus on emergency relief.'.
`(B) One mechanism to promote the transition from an emergency to a public health and development approach to HIV/AIDS is through compacts or framework agreements between the United States Government and each participating nation.
`(2) ELEMENTS- Compacts on HIV/AIDS authorized under subsection (d)(8) shall include the following elements:
`(A) Compacts whose primary purpose is to provide direct services to combat HIV/AIDS are to be made between--
`(i) the United States Government; and
`(ii)(I) national or regional entities representing low-income countries served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; or
`(II) countries or regions--
`(aa) experiencing significantly high HIV prevalence or risk of significantly increasing incidence within the general population;
`(bb) served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; and
`(cc) that have inadequate financial means within such country or region.
`(B) Compacts whose primary purpose is to provide limited technical assistance to a country or region connected to services provided within the country or region--
`(i) may be made with other countries or regional entities served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform;
`(ii) shall require significant investments in HIV prevention, care, and treatment services by the host country;
`(iii) shall be time-limited in terms of United States contributions; and
`(iv) shall be made only upon prior notification to Congress--
`(I) justifying the need for such compacts;
`(II) describing the expected investment by the country or regional entity; and
`(III) describing the scope, nature, expected total United States investment, and time frame of the limited technical assistance under the compact and its intended impact.
`(C) Compacts shall include provisions to--
`(i) promote local and national efforts to reduce stigma associated with HIV/AIDS; and
`(ii) work with and promote the role of civil society in combating HIV/AIDS.
`(D) Compacts shall take into account the overall national health and development and national HIV/AIDS and public health strategies of each country.
`(E) Compacts shall contain--
`(i) consideration of the specific objectives that the country and the United States expect to achieve during the term of a compact;
`(ii) consideration of the respective responsibilities of the country and the United States in the achievement of such objectives;
`(iii) consideration of regular benchmarks to measure progress toward achieving such objectives;
`(iv) an identification of the intended beneficiaries, disaggregated by gender and age, and including information on orphans and vulnerable children, to the maximum extent practicable;
`(v) consideration of the methods by which the compact is intended to--
`(I) address the factors that put women and girls at greater risk of HIV/AIDS; and
`(II) strengthen elements such as the economic, educational, and social status of women, girls, orphans, and vulnerable children and the inheritance rights and safety of such individuals;
`(vi) consideration of the methods by which the compact will--
`(I) strengthen the health care capacity, including factors such as the training, retention, deployment, recruitment, and utilization of health care workers;
`(II) improve supply chain management; and
`(III) improve the health systems and infrastructure of the partner country, including the ability of compact participants to maintain and operate equipment transferred or purchased as part of the compact;
`(vii) consideration of proposed mechanisms to provide oversight;
`(viii) consideration of the role of civil society in the development of a compact and the achievement of its objectives;
`(ix) a description of the current and potential participation of other donors in the achievement of such objectives, as appropriate; and
`(x) consideration of a plan to ensure appropriate fiscal accountability for the use of assistance.
`(F) For regional compacts, priority shall be given to countries that are included in regional funds and programs in existence as of the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
`(G) Amounts made available for compacts described in subparagraphs (A) and (B) shall be subject to the inclusion of--
`(i) cost sharing assurances that meet the requirements under section 110; and
`(ii) transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, and budget support by respective foreign governments.
`(3) LOCAL INPUT- In entering into a compact on HIV/AIDS authorized under subsection (d)(8), the Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall seek to ensure that the government of a country--
`(A) takes into account the local perspectives of the rural and urban poor, including women, in each country; and
`(B) consults with private and voluntary organizations, including faith-based organizations, the business community, and other donors in the country.
`(4) CONGRESSIONAL AND PUBLIC NOTIFICATION AFTER ENTERING INTO A COMPACT- Not later than 10 days after entering into a compact authorized under subsection (d)(8), the Global AIDS Coordinator shall--
`(A) submit a report containing a detailed summary of the compact and a copy of the text of the compact to--
`(i) the Committee on Foreign Relations of the Senate;
`(ii) the Committee on Appropriations of the Senate;
`(iii) the Committee on Foreign Affairs of the House of Representatives; and
`(iv) the Committee on Appropriations of the House of Representatives; and
`(B) publish such information in the Federal Register and on the Internet website of the Office of the Global AIDS Coordinator.'.
(e) Annual Report- Section 104A(f) of such Act, as redesignated, is amended--
(1) in paragraph (1), by striking `Committee on International Relations' and inserting `Committee on Foreign Affairs'; and
(A) in subparagraph (B), by striking `and' at the end;
(B) by striking subparagraph (C) and inserting the following:
`(C) a detailed breakdown of funding allocations, by program and by country, for prevention activities; and
`(D) a detailed assessment of the impact of programs established pursuant to such sections, including--
`(i)(I) the effectiveness of such programs in reducing--
`(aa) the transmission of HIV, particularly in women and girls;
`(bb) mother-to-child transmission of HIV, including through drug treatment and therapies, either directly or by referral; and
`(cc) mortality rates from HIV/AIDS;
`(II) the number of patients receiving treatment for AIDS in each country that receives assistance under this Act;
`(III) an assessment of progress towards the achievement of annual goals set forth in the timetable required under the 5-year strategy established under section 101 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and, if annual goals are not being met, the reasons for such failure; and
`(IV) retention and attrition data for programs receiving United States assistance, including mortality and loss to follow-up rates, organized overall and by country;
`(ii) the progress made toward--
`(I) improving health care delivery systems (including the training of health care workers, including doctors, nurses, midwives, pharmacists, laboratory technicians, and compensated community health workers, and the use of codes of conduct for ethical recruiting practices for health care workers);
`(II) advancing safe working conditions for health care workers; and
`(III) improving infrastructure to promote progress toward universal access to HIV/AIDS prevention, treatment, and care by 2013;
`(iii) a description of coordination efforts with relevant executive branch agencies to link HIV/AIDS clinical and social services with non-HIV/AIDS services as part of the United States health and development agenda;
`(iv) a detailed description of integrated HIV/AIDS and food and nutrition programs and services, including--
`(I) the amount spent on food and nutrition support;
`(II) the types of activities supported; and
`(III) an assessment of the effectiveness of interventions carried out to improve the health status of persons with HIV/AIDS receiving food or nutritional support;
`(v) a description of efforts to improve harmonization, in terms of relevant executive branch agencies, coordination with other public and private entities, and coordination with partner countries' national strategic plans as called for in the `Three Ones';
`(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;
`(I) the specific strategies funded to ensure the reduction of HIV infection among injection drug users;
`(II) the number of injection drug users, by country, reached by such strategies; and
`(III) medication-assisted drug treatment for individuals with HIV or at risk of HIV;
`(xi) a detailed description of program monitoring, operations research, and impact evaluation research, including--
`(I) the amount of funding provided for each research type;
`(II) an analysis of cost-effectiveness models; and
`(III) conclusions regarding the efficiency, effectiveness, and quality of services as derived from previous or ongoing research and monitoring efforts;
`(xii) building capacity to identify, investigate, and stop nosocomial transmission of infectious diseases, including HIV and tuberculosis; and
`(xiii) a description of staffing levels of United States government HIV/AIDS teams in countries with significant HIV/AIDS programs, including whether or not a full-time coordinator was on staff for the year.'.
(f) Authorization of Appropriations- Section 301(b) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631(b)) is amended--
(1) in paragraph (1), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'; and
(2) in paragraph (3), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'.
(g) Relationship To Assistance Programs To Enhance Nutrition- Section 301(c) of such Act is amended to read as follows:
`(c) Food and Nutritional Support-
`(1) IN GENERAL- As indicated in the report produced by the Institute of Medicine, entitled `PEPFAR Implementation: Progress and Promise', inadequate caloric intake has been clearly identified as a principal reason for failure of clinical response to antiretroviral therapy. In recognition of the impact of malnutrition as a clinical health issue for many persons living with HIV/AIDS that is often associated with health and economic impacts on these individuals and their families, the Global AIDS Coordinator
and the Administrator of the United 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;
`(iii) therapeutic and supplementary feeding;
`(D) provide food and nutritional support for children affected by HIV/AIDS and to communities and households caring for children affected by HIV/AIDS; and
`(E) in communities where HIV/AIDS and food insecurity are highly prevalent, support programs to address these often intersecting health problems through community-based assistance programs, with an emphasis on sustainable approaches.
`(2) AUTHORIZATION OF APPROPRIATIONS- Of the amounts authorized to be appropriated under section 401, there are authorized to be appropriated to the President such sums as may be necessary for each of the fiscal years 2009 through 2013 to carry out this subsection.'.
(h) Eligibility for Assistance- Section 301(d) of such Act is amended to read as follows:
`(d) Eligibility for Assistance- An organization, including a faith-based organization, that is otherwise eligible to receive assistance under section 104A of the Foreign Assistance Act of 1961, under this Act, or under any amendment made by this Act or by the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, for HIV/AIDS prevention, treatment, or care--
`(1) shall not be required, as a condition of receiving such assistance--
`(A) to endorse or utilize a multisectoral or comprehensive approach to combating HIV/AIDS; or
`(B) to endorse, utilize, make a referral to, become integrated with, or otherwise participate in any program or activity to which the organization has a religious or moral objection; and
`(2) shall not be discriminated against in the solicitation or issuance of grants, contracts, or cooperative agreements under such provisions of law for refusing to meet any requirement described in paragraph (1).'.
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Policy- Section 104B(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3(b)) is amended to read as follows:
`(b) Policy- It is a major objective of the foreign assistance program of the United States to control tuberculosis. In all countries in which the Government of the United States has established development programs, particularly in countries with the highest burden of tuberculosis and other countries with high rates of tuberculosis, the United States should support the objectives of the Global Plan to Stop TB, including through achievement of the following goals:
`(1) Reduce by half the tuberculosis death and disease burden from the 1990 baseline.
`(2) Sustain or exceed the detection of at least 70 percent of sputum smear-positive cases of tuberculosis and the successful treatment of at least 85 percent of the cases detected in countries with established United States Agency for International Development tuberculosis programs.
`(3) In support of the Global Plan to Stop TB, the President shall establish a comprehensive, 5-year United States strategy to expand and improve United States efforts to combat tuberculosis globally, including a plan to support--
`(A) the successful treatment of 4,500,000 new sputum smear tuberculosis patients under DOTS programs by 2013, primarily through direct support for needed services, commodities, health workers, and training, and additional treatment through coordinated multilateral efforts; and
`(B) the diagnosis and treatment of 90,000 new multiple drug resistant tuberculosis cases by 2013, and additional treatment through coordinated multilateral efforts.'.
(b) Priority To Stop TB Strategy- Section 104B(e) of such Act is amended to read as follows:
`(e) Priority To Stop TB Strategy- In furnishing assistance under subsection (c), the President shall give priority to--
`(1) direct services described in the Stop TB Strategy, including expansion and enhancement of Directly Observed Treatment Short-course (DOTS) coverage, rapid testing, treatment for individuals infected with both tuberculosis and HIV, and treatment for individuals with multi-drug resistant tuberculosis (MDR-TB), strengthening of health systems, use of the International Standards for Tuberculosis Care by all providers, empowering individuals with tuberculosis, and enabling and promoting research to develop n
ew 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 add
ressing multiple drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB).'.
(d) Annual Report- Section 104B of such Act is amended by inserting after subsection (f), as added by subsection (c) of this section, the following:
`(g) Annual Report- The President shall submit an annual report to Congress that describes the impact of United States foreign assistance on efforts to control tuberculosis, including--
`(1) the number of tuberculosis cases diagnosed and the number of cases cured in countries receiving United States bilateral foreign assistance for tuberculosis control purposes;
`(2) a description of activities supported with United States tuberculosis resources in each country, including a description of how those activities specifically contribute to increasing the number of people diagnosed and treated for tuberculosis;
`(3) in each country receiving bilateral United States foreign assistance for tuberculosis control purposes, the percentage provided for direct tuberculosis services in countries receiving United States bilateral foreign assistance for tuberculosis control purposes;
`(4) a description of research efforts and clinical trials to develop new tools to combat tuberculosis, including diagnostics, drugs, and vaccines supported by United States bilateral assistance;
`(5) the number of persons who have been diagnosed and started treatment for multidrug-resistant tuberculosis in countries receiving United States bilateral foreign assistance for tuberculosis control programs;
`(6) a description of the collaboration and coordination of United States anti-tuberculosis efforts with the World Health Organization, the Global Fund, and other major public and private entities within the Stop TB Strategy;
`(7) the constraints on implementation of programs posed by health workforce shortages and capacities;
`(8) the number of people trained in tuberculosis control; and
`(9) a breakdown of expenditures for direct patient tuberculosis services, drugs and other commodities, drug management, training in diagnosis and treatment, health systems strengthening, research, and support costs.'.
(e) Definitions- Section 104B(h) of such Act, as redesignated by subsection (c), is amended--
(1) in paragraph (1), by striking the period at the end and inserting the following: `including--
`(A) low-cost and effective diagnosis, treatment, and monitoring of tuberculosis;
`(B) a reliable drug supply;
`(C) a management strategy for public health systems;
`(D) health system strengthening;
`(E) promotion of the use of the International Standards for Tuberculosis Care by all care providers;
`(F) bacteriology under an external quality assessment framework;
`(G) short-course chemotherapy; and
`(H) sound reporting and recording systems.'; and
(2) by redesignating paragraph (5) as paragraph (6); and
(3) by inserting after paragraph (4) the following:
`(5) STOP TB STRATEGY- The term `Stop TB Strategy' means the 6-point strategy to reduce tuberculosis developed by the World Health Organization, which is described in the Global Plan to Stop TB 2006-2015: Actions for Life, a comprehensive plan developed by the Stop TB Partnership that sets out the actions necessary to achieve the millennium development goal of cutting tuberculosis deaths and disease burden in half by 2015.'.
(f) Authorization of Appropriations- Section 302 (b) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended--
(1) in paragraph (1), by striking `such sums as may be necessary for each of the fiscal years 2004 through 2008' and inserting `a total of $4,000,000,000 for the 5-year period beginning on October 1, 2008.'; and
(2) in paragraph (3), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013.'.
SEC. 303. ASSISTANCE TO COMBAT MALARIA.
(a) Amendment to the Foreign Assistance Act of 1961- Section 104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-4(b)) is amended by inserting `treatment,' after `control,'.
(b) Authorization of Appropriations- Section 303 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
(A) in paragraph (1), by striking `such sums as may be necessary for fiscal years 2004 through 2008' and inserting `$5,000,000,000 during the 5-year period beginning on October 1, 2008'; and
(B) in paragraph (3), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'; and
(2) by adding at the end the following:
`(c) Statement of Policy- Providing assistance for the prevention, control, treatment, and the ultimate eradication of malaria is--
`(1) a major objective of the foreign assistance program of the United States; and
`(2) 1 component of a comprehensive United States global health strategy to reduce disease burdens and strengthen communities around the world.
`(d) Development of a Comprehensive 5-Year Strategy- The President shall establish a comprehensive, 5-year strategy to combat global malaria that--
`(1) strengthens the capacity of the United States to be an effective leader of international efforts to reduce malaria burden;
`(2) maintains sufficient flexibility and remains responsive to the ever-changing nature of the global malaria challenge;
`(3) includes specific objectives and multisectoral approaches and strategies to reduce the prevalence, mortality, incidence, and spread of malaria;
`(4) describes how this strategy would contribute to the United States' overall global health and development goals;
`(5) clearly explains how outlined activities will interact with other United States Government global health activities, including the 5-year global AIDS strategy required under this Act;
`(6) expands public-private partnerships and leverage of resources;
`(7) coordinates among relevant Federal agencies to maximize human and financial resources and to reduce duplication among these agencies, foreign governments, and international organizations;
`(8) coordinates with other international entities, including the Global Fund;
`(9) maximizes United States capabilities in the areas of technical assistance and training and research, including vaccine research; and
`(10) establishes priorities and selection criteria for the distribution of resources based on factors such as--
`(A) the size and demographics of the population with malaria;
`(B) the needs of that population;
`(C) the country's existing infrastructure; and
`(D) the ability to closely coordinate United States Government efforts with national malaria control plans of partner countries.'.
SEC. 304. MALARIA RESPONSE COORDINATOR.
Section 304 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended to read as follows:
`SEC. 304. MALARIA RESPONSE COORDINATOR.
`(a) In General- There is established within the United States Agency for International Development a Coordinator of United States Government Activities to Combat Malaria Globally (referred to in this section as the `Malaria Coordinator'), who shall be appointed by the President.
`(b) Authorities- The Malaria Coordinator, acting through nongovernmental organizations (including faith-based and community-based organizations), partner country finance, health, and other relevant ministries, and relevant executive branch agencies as may be necessary and appropriate to carry out this section, is authorized to--
`(1) operate internationally to carry out prevention, care, treatment, support, capacity development, and other activities to reduce the prevalence, mortality, and incidence of malaria;
`(2) provide grants to, and enter into contracts and cooperative agreements with, nongovernmental organizations (including faith-based organizations) to carry out this section; and
`(3) transfer and allocate executive branch agency funds that have been appropriated for the purposes described in paragraphs (1) and (2).
`(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;
`(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 k
ey 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.
`(1) SUBMISSION- Not later than 1 year after the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, and annually thereafter, the President shall submit a report to the appropriate congressional committees that describes United States assistance for the prevention, treatment, control, and elimination of malaria.
`(2) CONTENTS- The report required under paragraph (1) shall describe--
`(A) the countries and activities to which malaria resources have been allocated;
`(B) the number of people reached through malaria assistance programs, including data on children and pregnant women;
`(C) research efforts to develop new tools to combat malaria, including drugs and vaccines;
`(D) the collaboration and coordination of United States antimalarial efforts with the World Health Organization, the Global Fund, the World Bank, other donor governments, major private efforts, and relevant executive agencies;
`(E) the coordination of United States antimalarial efforts with the national malarial strategies of other donor or partner governments and major private initiatives;
`(F) the estimated impact of United States assistance on childhood mortality and morbidity from malaria;
`(G) the coordination of antimalarial efforts with broader health and development programs; and
`(H) the constraints on implementation of programs posed by health workforce shortages or capacities; and
`(I) the number of personnel trained as health workers and the training levels achieved.'.
SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.
Section 212(a)(1)(A)(i) of the Immigration and Nationality Act (8 U.S.C. 1182(a)(1)(A)(i)) is amended by striking `, which shall include infection with the etiologic agent for acquired immune deficiency syndrome,' and inserting a semicolon.
SEC. 306. CLERICAL AMENDMENT.
Title III of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is amended by striking the heading for subtitle B and inserting the following:
`Subtitle B--Assistance for Women, Children, and Families'.
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.'.
SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV.
Section 313(a) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) is amended by striking `5 years' and inserting `10 years'.
SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT PANEL.
Section 312 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) is amended by adding at the end the following:
`(c) Prevention of Mother-to-Child Transmission Expert Panel-
`(1) ESTABLISHMENT- The Global AIDS Coordinator shall establish a panel of experts to be known as the Prevention of Mother-to-Child Transmission Panel (referred to in this subsection as the `Panel') to--
`(A) provide an objective review of activities to prevent mother-to-child transmission of HIV; and
`(B) provide recommendations to the Global AIDS Coordinator and to the appropriate congressional committees for scale-up of mother-to-child transmission prevention services under this Act in order to achieve the target established in subsection (b)(1).
`(2) MEMBERSHIP- The Panel shall be convened and chaired by the Global AIDS Coordinator, who shall serve as a nonvoting member. The Panel shall consist of not more than 15 members (excluding the Global AIDS Coordinator), to be appointed by the Global AIDS Coordinator not later than 1 year after the date of the enactment of this Act, including--
`(A) 2 members from the Department of Health and Human Services with expertise relating to the prevention of mother-to-child transmission activities;
`(B) 2 members from the United States Agency for International Development with expertise relating to the prevention of mother-to-child transmission activities;
`(C) 2 representatives from among health ministers of national governments of foreign countries in which programs under this Act are administered;
`(D) 3 members representing organizations implementing prevention of mother-to-child transmission activities under this Act;
`(E) 2 health care researchers with expertise relating to global HIV/AIDS activities; and
`(F) representatives from among patient advocate groups, health care professionals, persons living with HIV/AIDS, and non-governmental organizations with expertise relating to the prevention of mother-to-child transmission activities, giving priority to individuals in foreign countries in which programs under this Act are administered.
`(3) DUTIES OF PANEL- The Panel shall--
`(A) assess the effectiveness of current activities in reaching the target described in subsection (b)(1);
`(B) review scientific evidence related to the provision of mother-to-child transmission prevention services, including programmatic data and data from clinical trials;
`(C) review and assess ways in which the Office of the United States Global AIDS Coordinator collaborates with international and multilateral entities on efforts to prevent mother-to-child transmission of HIV in affected countries;
`(D) identify barriers and challenges to increasing access to mother-to-child transmission prevention services and evaluate potential mechanisms to alleviate those barriers and challenges;
`(E) identify the extent to which stigma has hindered pregnant women from obtaining HIV counseling and testing or returning for results, and provide recommendations to address such stigma and its effects;
`(F) identify opportunities to improve linkages between mother-to-child transmission prevention services and care and treatment programs; and
`(G) recommend specific activities to facilitate reaching the target described in subsection (b)(1).
`(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).'.
Speaker of the House of Representatives
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Vice President of the United States and
President of the Senate
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