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TheWeekInCongress.com (TM) Week Ending April 4, 2008
H.R.5501 To authorize appropriations for fiscal years 2009 through 2013 to provide assistance to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and for other purposes.
{Note: the Senate replaced the text of HR 5501 with the text of S 2731. Bills are nearly identical}
A five-year strategic plan is ordered to further the US Global Leadership Against HIV/AIDS, Tuberculosis and Malaria. The plan will monitor, research and assess impact evaluation research. The vaccine fund and vaccine initiatives are also supported. The bill is designed to shift the HIV fighting emphasis over the past five years from meeting emergency needs to a long-term strategy.
Simplistically the bill is "aimed at prevention with strong emphasis on delay of sexual debut, abstinence, partner reduction, and life-skills programs, particularly for women and girls." and allows for condom distribution. Various internal program changes are included.
The US Agency for International Development is directed to develop a program to facilitate the availability of proven microbicides that prevent transmission of HIV. The Coordinator of the US Government Activities to Combat HIV/AIDS Globally is directed to develop a plan to combat HIV/AIDS by strengthening health policies and health systems in Host countries. It is to be US policy to aid recipient countries in fighting the diseases and implementing five-year workforce strategies.
The President is authorized to increase resources to the World Health Organization regarding tuberculosis and a coordinator position is established to oversee efforts to fight malaria globally. The President is also directed to formulate a comprehensive prevention strategy that addresses the vulnerabilities of women and youth to HIV infection.
The Secretary of the Treasury shall instruct the United States Executive Director at the International Monetary Fund to use the voice, vote, and influence of the United States to oppose any loan, project, agreement, memorandum, instrument, plan, or other program of the International Monetary Fund that does not exempt increased government spending on health care from national budget caps or restraints, hiring or wage bill ceilings, or other limits sought by any international financial institution.
The Coordinator of United States Government Activities to Combat AIDS Globally shall work with the Partnership for Supply Chain Management Systems, host countries, and nongovernmental organizations to develop effective, reliable host country-owned and operated public-sector procurement and supply chain management systems, including regional distribution, with ongoing technical assistance and sustained support to ensure the function of such systems, as well as the function of existing non-public sector supply chains, including those operated by faith-based and other humanitarian organizations that procure and distribute medical supplies.
None of the funds appropriated may be made available to provide assistance for a foreign country under a new bilateral agreement governing the terms and conditions under which such assistance is to be provided unless such agreement includes a provision stating that assistance provided by the United States shall be exempt from taxation, or reimbursed, by the foreign government.
Positive Broader Health Impact- It shall be the policy of the United States to ensure to expand the capacity of the health workforce engaged in HIV/AIDS programming in ways that contribute to, and do not detract from, the capacity of countries to meet other health needs, particularly child survival and maternal health.
Safety for Health Workers- It is the sense of Congress that the United States should ensure that all health workers participating in programs that receive assistance under this Act and the amendments made by this Act have the proper training to create safe and sanitary working conditions in accordance with universal precautions and other forms of infection prevention and control.
Tuberculosis TB is to be restrained through referrals of HIV patients afflicted with TB and enhanced testing in countries with high TB rates. New strategies are to be created to further combat the spread of TB. The over all strategy is to cut TB deaths in half by 2016.
Malaria The President is directed to develop a comprehensive 5–year strategy to combat malaria globally and strengthen United States leadership against this disease. A new position of coordinator is established. The US CDC will become involved in various treatment strategies.
Amendment activity would add safe drinking water to improved nutrition and income security factors for fighting TB and Malaria, add audits of contract workers to the inspector general oversight activities, add add Malawi, Swaziland and Lesotho to the list of focus countries, and require USAID to expand its plan for strengthening health systems of host countries by allowing for postsecondary educational institutions, particularly in Africa, to collaborate with United States postsecondary educational institutions and specifically historically black colleges and universities.
Sponsor: Rep. Howard Berman (D-CA-28th) Vote: Passed House 308 to 116 RC 158 April 2, 2008. The Minority Motion to Recommit the bill failed 175 to 248 RC 157 The Senate amended the bill and replaced the bill text with the text of S 2731. The bills are nearly identical. The Senate bill does not include, as the House bill does, funds for birth control provisions in undeveloped nations. Passed Senate amended 80 to 16 July 16, 2008 RV 182. The House concurred with the Senate amendment July 24, 2008 303 to 115 RC 531 Cost to the taxpayers: Approximately $12 million is identified. Other provisions in the bill are funded at such sums as may be necessary. The bill is expected to spend $50 billion over five years. ## All Rights Reserved. © 2008 TheWeekInCongress.com(TM) No reproduction, language translation or distribution without written permission from TheWeekInCongress.com.(TM) MORE INFORMATION
Background and support for the legislation
BACKGROUND AND PURPOSE FOR THE LEGISLATIONIn his State of the Union address in 2003, President George W. Bush announced the `President's Emergency Plan for AIDS Relief' (PEPFAR), requesting $15 billion to intervene in the worst global health pandemic since the Plague. In 2003, according to UNAIDS, 3 million people were newly infected with HIV and 2 million died. Worldwide, an estimated 30.9 million people were living with HIV/AIDS. Sub-Saharan Africa, the most severely affected region of the world, accounted for over 2.1 million of these new infections and 1.6 million AIDS deaths. Every day in 2003, an estimated 8,200 people were newly infected with HIV worldwide. 1 [Footnote] At the time, antiretroviral drug treatment regimens in poor settings were viewed by some policy makers as prohibitively expensive and complicated. Primary focus was on the cheaper and more easily administered drugs for the prevention of mother-to-child transmission. [Footnote 1: UNAIDS, 2007] Soon after the President's announcement, Congress passed and the President signed the `U.S Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003,' Public Law 108-25 (`the 2003 Act'), authorizing $15 billion in assistance to combat these diseases for Fiscal Years 2004--2008. 2 [Footnote] President Bush signed the Act into law in May 2003. [Footnote 2: The efforts were concentrated primarily in 14 `focus countries'--Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. Vietnam was later added as a 15th focus country, and PEPFAR also supports bilateral programs in dozens of other countries.] The 2003 Act established, within the Department of State, a Coordinator of United States Government Activities to Combat HIV/AIDS Globally, appointed by the President with the advice and consent of the Senate. The Office of the Global AIDS Coordinator (OGAC) now leads interagency implementation of and administers U.S. global HIV/AIDS policy. The Reauthorization Act seeks to strengthen the Coordinator's role of coordinating the Federal agencies engaged in implementing global HIV/AIDS policy. The 2003 Act required a five-year emergency plan (2004-2008) designed to coordinate all U.S.-funded bilateral HIV/AIDS programs, including those established by PEPFAR and administered through the seven implementing agencies, 3 [Footnote] to address the emergency. With this new funding, combined with other HIV/AIDS program funding, the U.S. bilateral programs to combat HIV/AIDS, tuberculosis, and malaria were expanded to 114 countries. The U.S. now supports programs in 136 countries, including programs funded by the United States and administered through The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), an international financing mechanism for collective global funding of programs to combat these three diseases. A major goal of the 2003 Act was to focus the delivery of services through local community and faith-based organizations in the host countries. On World AIDS Day in 2005, the President announced the creation of `The New Partners Initiative' (NPI) to provide technical assistance enabling faith-based and community organizations with little prior experience working with the U.S. Government to administer sustainable HIV/AIDS programs. [Footnote 3: Department of State, USAID, Department of Defense, Department of Commerce, Department of Labor, Department of Health and Human Services and the Peace Corps.] The initial `emergency phase' was also designed to scale up HIV/AIDS treatment, care, and prevention programs (including prevention of mother-to-child transmission programs), and extend them to hard-to-reach rural areas and vulnerable populations, including women, girls, orphans and vulnerable children. The three major infectious diseases--HIV/AIDS, TB, and malaria--were covered by the 2003 Act because research demonstrated that co-infection with HIV/AIDS and one or both of the other diseases resulted in more severe symptoms and certain and untimely death. For example, according to the World Health Organization (WHO), 90% of people living with AIDS die within months of contracting TB if they do not receive TB treatment. 4 [Footnote] [Footnote 4: `Frequently Asked Questions About TB and HIV/AIDS,' World Health Organization, 2008.] For the past five years, the United States has been the leading international provider of global HIV/AIDS support for prevention, treatment, and care. Over this period, Congress appropriated more funds than were initially authorized. In Fiscal Years 2004 through 2008, the U.S. appropriated more than $19 billion for programs to combat HIV/AIDS, tuberculosis and malaria internationally, including more than $3 billion in contributions to The Global Fund. The U.S. emergency program intervened in this horrific pandemic and performed well in the face of a massive humanitarian disaster, broken infrastructure and a major shortage of health care workers. As of September 30, 2007: the U.S. had supported life-saving antiretroviral treatment for 1,445,500 men, women, and children; supported care for more than 6.6 million, including care for more than 2.7 million orphans and vulnerable children; and supported prevention of an estimated 157,000 infant infections (cumulative for Fiscal Years 2004 through 2007). In virtually every host country, in order to treat and care for individuals, major investment in infrastructure and workforce training has taken place, though there is still much more to be done. Shortages of health care workers, clinics, hospitals, laboratories, and storage facilities in many areas of host countries have made it incredibly difficult to reach vast numbers of individuals who needed care and treatment. By 2007, the news, while still grim, was beginning to improve. The HIV/AIDS prevalence rates were leveling off and annual deaths stabilized. According to UNAIDS, in 2007 there were 33.2 million people worldwide living with HIV/AIDS, of whom 2.5 million were children under the age of 15; 2.5 million were newly infected, of whom 420,000 were children under the age of 15; and there were 2.1 million deaths, of whom 330,000 were children under the age of 15. Due to the massive intervention by the U.S. Government, the Global Fund, other bilateral donors, and the governments and people of the countries most affected by the disease, the growth of the pandemic has slowed and the estimates are headed in the right direction. Host countries that have partnered with the U.S. to fight HIV/AIDS have expressed their deep appreciation of the program. As President Jakaya Kikwete of Tanzania said when talking to President Bush in February 2008, `Today there are thousands of children who have managed to avoid joining the already long list of orphans, and who continue to enjoy the love, guidance and support of their parents who are alive because of the AIDS care and treatment they get with the support of PEPFAR initiative. Mr. President, thank you. Today, as a result of PEPFAR, parents with AIDS are able to take care of their children.' 5 [Footnote] [Footnote 5: Joint Press Availability with President Kikwete and President Bush in Tanzania, 2/17/08] In September 2007, President Festus Mogae of Botswana said, `. . . The modest successes we have recorded in my country . . . and indeed in many African countries, could not have been achieved without United States support under the President Bush's Emergency Fund for AIDS Relief, PEPFAR. . . . The fund has, in addition, provided impetus to other donors and major contributors to contribute to international efforts to fight the scourge of HIV/AIDS around the world. The quantum of resources under PEPFAR, a significant amount from a single source by any standard, has helped translate international consensus into tangible opportunity and hope for millions around the world. . . . PEPFAR has galvanized donor countries and agencies alike to act in concert in the interest of humanity.' 6 [Footnote] [Footnote 6: `Botswana's Future: Reflections on HIV/AIDS, Democratization, and U.S.-Botswana Relations,' Center for Strategic & International Studies, Washington, DC, 9/21/2007.] While the program has been able to reach a large number of people, the more difficult challenges lie ahead. The number of those receiving prevention, treatment, and care services needs to increase towards the goal of universal access, and host country programs must be strengthened to sustain those on treatment for life. Measures must be taken to create sustainability of host country HIV/AIDS programs far into the future. Research is needed to address further developments of the virus and the disease. Lastly, health care delivery systems strengthening and maintenance and workforce stability must be achieved. Without these improvements, the threat of a rapid expansion of HIV/AIDS in countries where the epidemic has become generalized and into countries that have relatively low prevalence rates remains grave. Amendment offered by Mr. Blumenauer. An amendment numbered 1 printed in House Report 110-562 to add safe drinking water to nutrition and income security on the list of programs for which direct linkages are encouraged. Agreed to by voice vote April 2, 2008 Amendment offered by Mr. Fortenberry. An amendment numbered 2 printed in House Report 110-562 to ensure that audits by the Inspector General include information on subcontractors. Agreed to by voice vote April 2, 2008 Amendment offered by Ms. McCollum (MN). An amendment numbered 3 printed in House Report 110-562 to add Malawi, Swaziland and Lesotho to the list of new `focus' countries proposed to be added in the bill. Agreed to by voice vote April 2, 2008 Amendment offered by Mr. Carson. An amendment numbered 4 printed in House Report 110-562 to direct the Coordinator of United States Government Activities to Combat HIV/AIDS Globally and the Administrator of the United States Agency for International Development to expand their plan for strengthening health systems of host countries by allowing for postsecondary educational institutions, particularly in Africa, to collaborate with United States postsecondary educational institutions and specifically historically black colleges and universities. Agreed to in the House 415 to 10 RC 156 April 3, 2008 Senate Amendments 1.
S.AMDT.5073 to
S.2731
In the nature of a substitute. 2.
S.AMDT.5074 to
S.2731
Purpose will be available when the amendment is proposed for
consideration. See Congressional Record for text. 3.
S.AMDT.5075 to
S.2731
In the nature of a substitute. 4.
S.AMDT.5076 to
S.2731
To provide for an emergency plan for Indian Safety and health. 5.
S.AMDT.5077 to
S.2731
To reduce to $35,000,000,000 the amount authorized to be appropriated to
combat HIV/AIDS, tuberculosis, and malaria in developing countries during
the next 5 years. 6.
S.AMDT.5078 to
S.2731
To limit the countries to which Federal financial assistance may be
targeted under this Act. 7.
S.AMDT.5079 to
S.2731
To prevent certain uses of the Global Fund. 8.
S.AMDT.5080 to
S.2731
Purpose will be available when the amendment is proposed for
consideration. See Congressional Record for text. 9.
S.AMDT.5081 to
S.2731
To strike the provision requiring the development of coordinated oversight
plans and to establish an independent Inspector General at the Office of
the Global AIDS Coordinator. 10.
S.AMDT.5082 to
S.2731
To limit the period during which appropriations may be made to carry out
this Act and to create a point of order in the Senate against any
appropriation to carry out this Act that exceeds the amount authorized for
fiscal year 2013. 11.
S.AMDT.5083 to
S.2731
To establish a bipartisan commission for the purpose of improving
oversight and eliminating wasteful government spending under the
President's Emergency Plan for AIDS Relief. 12.
S.AMDT.5084 to
S.2731
To reallocate the distribution of funds from the Emergency Fund for Indian
Safety and Health. 13.
S.AMDT.5085 to
S.2731
To encourage the inclusion of cost sharing assurances and transition
strategies among compacts and frameworks agreements, the activities
authorized under section 104A of the Foreign Assistance Act of 1961, and
the highest priorities of the Federal Government. 14.
S.AMDT.5086 to
S.2731
To withhold 20 percent of the Federal funding appropriated for the Global
Fund until the Secretary certifies that the Global Fund has provided the
State Department with access to financial and other data. 15.
S.AMDT.5087 to
S.2731
To advise the public about the risks of contracting HIV from blood
exposures, to investigate unexplained infections, and to promote universal
precautions in health care settings.
Section-by Section Analysis SECTION-BY-SECTION ANALYSIS AND DISCUSSIONSec. 1. Short Title and Table of Contents. The short title of this Act is the `Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008'. Sec. 2. Findings. This section amends the findings in the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (22 U.S.C. 7601) (`the 2003 Act') by adding to the end of that Act's findings, additional findings with updated data on human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS), hereinafter collectively referred to as HIV/AIDS, tuberculosis and malaria around the world and the impact of U.S. assistance in combating these diseases since the 2003 Act was passed. The findings also identify ongoing and growing challenges in meeting the needs for treatment, care, prevention, cure and research of and related to these diseases in coming years. Sec. 3. Definitions. This section amends the 2003 Act by updating the title of the Committee to the `Committee on Foreign Affairs.' Sec. 4. Purpose. This section amends the purpose of the 2003 Act by adding the creation of five-year plans for tuberculosis and malaria; calling for increased resources for bilateral efforts for prevention, treatment and care; expanding this assistance to cover nutrition assistance, heath system and workforce development, monitoring and evaluations and operations research; and including efforts to develop research for tuberculosis and other prevention technologies. TITLE I--POLICY PLANNING AND COORDINATIONSec. 101. Development of a Comprehensive, Five-Year, Global Strategy. This section amends section 101 of the 2003 Act by providing additional guidance to the President on the development of the second five-year plan to combat HIV/AIDS globally. It instructs the President to expand the strategic approach to behavioral risks related to transmission of HIV/AIDS. It instructs the President to provide for linkages and referral systems to nutrition and food support for individuals with HIV/AIDS, child health services and development programs, and other social service programs related to HIV/AIDS. It also calls on the President to provide access to HIV/AIDS education and testing in family planning and maternal health programs supported by the United States Government, and to maximize host country capacity for HIV/AIDS training and research in the five-year strategy. Sec. 102. HIV/AIDS Response Coordinator. This section amends section 1(f)(2) of the State Department Basic Authorities Act of 1956 (22 U.S.C. 2651a(f)(2)) to strengthen and expand the duties of the HIV/AIDS Response Coordinator, including enhancing the role of the Coordinator in consulting and coordinating with foreign governments, nongovernmental organizations and other U.S. Government agencies. TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE PARTNERSHIPSSec. 201. Sense of Congress on Public-Private Partnerships. This section amends section 201 of the 2003 Act by updating the purpose of public-private partnerships to address easily preventable and treatable infectious diseases. Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria. This section amends section 202 of the 2003 Act relating to U.S. contributions to the Global Fund. Subsection (a) updates findings in that Act. Subsection (b) increases the annual authorization for the U.S. contribution to the Global Fund from $1 billion to $2 billion for Fiscal Years 2009 and 2010 of the amounts authorized to be appropriated under section 401 of the 2003 Act. It also moves the deadline after which funds appropriated for such contribution can be transferred to the U.S. bilateral programs from July 1 to December 31 of the year after the funds are appropriated (if they are available for more than one fiscal year) and provides new benchmarks designed to improve the accountability and transparency of the Global Fund's activities. Sec. 203. Voluntary Contributions to International Vaccine Funds. This section amends section 302 of the Foreign Assistance Act of 1961 to reauthorize the existing programs for the vaccine fund authorized under section 302(k) of that Act, the International AIDS Vaccine authorized by section 302(l) of such Act and the malaria vaccine development program authorized by section 302(m) of such Act. Section 203 also adds a new section 302(n) relating to authorizing a U.S. contribution to research and development of a tuberculosis vaccine. Sec. 204. Program to Facilitate Availability of Microbicides to Prevent Transmission of HIV and Other Diseases. Subsection (a) expresses the sense of Congress recognizing the need and urgency to expand the range of interventions for preventing the transmission of HIV, including non-vaccine prevention methods that can be controlled by women. Subsection (b) authorizes the Administrator of USAID, in coordination with the Coordinator of U.S. Government Activities to Combat HIV/AIDS Globally, to develop and implement a program to facilitate wide scale availability of microbicides that prevent the transmission of HIV after such microbicides are proven safe and effective. Subsection (c) authorizes of the amounts authorized by section 401 of the 2003 Act, such sums as may be necessary for Fiscal Years 2009 through 2013 to carry out this section. Sec. 205. Plan to Combat HIV/AIDS, Tuberculosis, and Malaria by Strengthening Health Policies and Health Systems of Host Countries. This section amends Title II of the 2003 Act by adding a new section 204 relating to strengthening health policies and health systems of host countries. Subsection (a) provides findings on the need for strengthening of such health policies and systems. Subsection (b) provides for a statement of policy directed to this need. Subsection (c) requires the Coordinator to develop and implement a plan to combat HIV/AIDS by strengthening such policies and systems as part of the United States Agency for International Development's `Health Systems 2020 Project.' Subsection (d) authorizes the appropriation of funds authorized under section 401 of the Act to the Department of the Treasury to provide technical assistance to host countries to improve the public finance management systems of such countries to enable them to receive HIV/AIDS assistance, collect revenue and manage their own programs. TITLE III--BILATERAL EFFORTSSubtitle A--General Assistance and Programs Sec. 301. Assistance to Combat HIV/AIDS. This section amends section 104A of the Foreign Assistance Act of 1961 and section 301 of the 2003 Act, both of which relate to bilateral U.S. HIV/AIDS assistance. Subsection (a) amends section 104A by updating and sharpening the focus on certain assistance activities. In particular, the amendments to section 104A create new targets for U.S. HIV/AIDS assistance by 2013 of preventing 12 million infections, treating 3 million persons with HIV/AIDS and caring for 12 million individuals (including 5 million HIV/AIDS orphans and vulnerable children), and training health workers and professionals for HIV/AIDS prevention, treatment and care; widening U.S. efforts to regions such as Central and Eastern Europe and South and Southeast Asia; and creating a new focus on support for host countries. Subsection (a) also expands the activities for which U.S. HIV/AIDS assistance can be used for prevention, including an increased focus on counseling, delay of sexual debut, abstinence, fidelity, life skills, prevention of mother-to-child HIV transmission, and the use of safe and effective microbicides when they become available. It also expands activities for treatment, including assistance to support treatment for one-third of all individuals in clinical need of treatment in the poorest countries worldwide, assistance to reduce barriers to treatment, and assistance for psycho-social treatment for youth to ensure adherence to treatment. It also provides for a more integrated approach to HIV/AIDS by supporting referral of individuals with HIV/AIDS to relevant services and enhanced support of related programs that can improve the effectiveness of HIV/AIDS programs, such as nutrition, education, and programs that improve the livelihood of individuals with HIV/AIDS. Subsection (a) also expands the annual report required by section 104A(e) to address a number of the new approaches described in this Act. Subsection (b) amends section 301 of the 2003 Act to expand the authorization to Fiscal Years 2009 through 2013. Subsection (c) amends section 301(c) of the 2003 Act to create an enhanced focus on food and nutrition assistance as critical to an integrated approach to treatment of individuals with HIV/AIDS. Subsection (d) clarifies that not only are groups receiving funds under the Act not required to endorse or utilize any activities or programs to which they have a moral or religious objection, they are also not required to integrate with or refer to programs to which they have a moral or religious objection. Subsection (e) repeals a sense of Congress that is superfluous in light of the amendment made by subsection (c). Subsection (f) requires the Coordinator to provide a report identifying a target for the number of additional health professionals and workers needed in host countries to provide HIV/AIDS prevention, treatment and care. Sec. 302. Assistance to Combat Tuberculosis. Subsection (a) makes amendments to section 104B of the Foreign Assistance Act of 1961 relating to assistance to combat tuberculosis, drawing from the House-passed version of H.R. 1567, the Stop Tuberculosis (TB) Now Act of 2007. These amendments include additional findings and an amended statement of policy; a requirement to provide assistance to combat tuberculosis; and a list of activities to be carried out, including diagnostic testing and counseling, treatment, and integration of HIV/AIDS and tuberculosis training. The amendments also include providing for a new U.S. strategy to combat tuberculosis and an authorization to provide increased resources to the World Health Organization. Subsection (b) amends section 302 of the 2003 Act to authorize up to a total of $4 billion for Fiscal Years 2009 to 2013 from the overall amounts authorized by section 401 of the 2003 Act (as amended by this Act) for assistance to combat tuberculosis. Sec. 303. Assistance to Combat Malaria. Subsection (a) amends section 104C of the Foreign Assistance Act of 1961 to ensure that treatment is part of the U.S. effort to combat malaria. Subsection (b) amends section 303 of the 2003 Act to authorize up to a total of $5 billion for Fiscal Years 2009 to 2013 from the overall amounts authorized by section 401 of the 2003 Act (as amended by this Act) for assistance to combat malaria. Subsection (c) further amends section 303 of the 2003 Act by adding a requirement for a comprehensive strategy to combat malaria and to establish within USAID a malaria coordinator. It also provides for contributions to the Roll Back Malaria Partnership and the World Health Organization; for research by relevant U.S. agencies to address prevention, treatment and care of malaria; and for an annual report on the prevention, treatment, control and elimination of malaria. Sec. 304. Health Care Partnerships to Combat HIV/AIDS. This section supports the development of partnerships between institutions based in the United States and foreign institutions, including national and local health agencies, medical facilities, health education and training institutions, and faith- and community-based organizations involved in prevention, treatment and care of individuals with HIV/AIDS. Subtitle B--Assistance for Women, Children, and Families Sec. 311. Policy and Requirements. This section amends section 312 of the 2003 Act to provide for additional policy and other requirements. Subsection (a) provides for collaboration among all relevant actors that combat HIV/AIDS. Subsection (b) revises section 312(b) of the 2003 Act to provide for requirements regarding the five-year strategy required by section 101 of the 2003 Act, including establishing targets for reaching 80 percent of pregnant women for prevention of mother-to-child transmission (PMTCT) of HIV; for requiring that up to 15 percent of those receiving treatment and up to 15 percent of those receiving care from U.S. HIV/AIDS assistance are children; for integrating care and treatment with PMTCT programs; and for expanding programs to care for children orphaned by HIV/AIDS. Sec. 312. Annual Reports on Prevention of Mother-to-Child Transmission of the HIV Infection. This section amends section 313 of the 2003 Act by extending the duration of the annual PMTCT report required by such section and requires that such report include additional information on the number of women who receive various types of assistance related to PMTCT. Sec. 313. Strategy to Prevent HIV Infections Among Women and Youth. This section provides for a comprehensive, integrated and culturally appropriate global HIV/AIDS prevention strategy that addresses the vulnerabilities of women and youth. Subsection (a) provides a statement of policy regarding this matter. Subsection (b) requires the strategy and describes its elements. Subsection (c) provides, in formulating and implementing the strategy required by subsection (b), coordination with relevant actors involved in combating HIV/AIDS. Subsection (d) provides for guidance to field missions based on the strategy described in subsection (b). Subsection (e) requires a report on the implementation of the strategy. Sec. 314. Clerical Amendment. This section makes a clerical amendment to the 2003 Act. TITLE IV--AUTHORIZATION OF APPROPRIATIONSSec. 401. Authorization of Appropriations. This section increases the authorization under section 401(a) of the 2003 Act to $10 billion for each of the Fiscal Years 2009 to 2013. Sec. 402. Sense of Congress. This section amends the sense of Congress language included in section 402(b) of the 2003 Act to eliminate specific spending directives in the legislation, including the 55% directive, expressed as a sense of Congress, for treatment, and the directive, again expressed as a sense of Congress, that one-third of prevention funds be used for abstinence programs. Sec. 403. Allocation of Funds. This section amends section 403(a) of the 2003 Act to maintain focus on balanced prevention programming. In particular, the new subsection (a) provides that 20 percent of all funds authorized for HIV/AIDS programs by the Act shall be used to support HIV prevention programs. In addition, the revised section 403(a) includes a requirement that the Coordinator provide balanced funding for prevention activities for sexual transmission of HIV/AIDS and ensure that behavioral change programs, including abstinence, delay of sexual debut, monogamy, fidelity and partner reduction, are implemented and funded in a meaningful and equitable way in the strategy for each host country based on objective epidemiological evidence as to the source of infection and in consultation with the government of each host country involved in HIV/AIDS prevention activities. The new subsection also provides that the Coordinator shall establish a HIV sexual transmission prevention strategy governing the expenditure of funds authorized by the Act used to prevent the sexual transmission of HIV in any host country with a generalized epidemic. In each such host country, if this strategy provides less than 50 percent of such funds for behavioral change programs (defined to include abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction), the Coordinator shall, within 30 days of the issuance of this strategy, report to the appropriate congressional committees on the justification for this decision. Finally, this section extends the focus of the Act relating to orphans and vulnerable children. Sec. 404. Prohibition on Taxation by Foreign Governments. Subsection (a) provides that none of the funds appropriated pursuant to the authorization of the 2003 Act, as amended by this Act, may be made available to provide assistance for a foreign country under a new bilateral agreement governing the terms and conditions under which such assistance is to be provided unless such agreement includes a provision stating that assistance provided by the United States shall be exempt from taxation, or reimbursed, by the foreign government, and the Secretary of State shall expeditiously seek to negotiate amendments to existing bilateral agreements, as necessary, to conform with this requirement. Subsection (b) provides for a de minimus exception to this section. Subsection (c) authorizes that any funds withheld pursuant to subsection (a) shall be reprogrammed for HIV/AIDS assistance to another country. Subsection (d) provides that subsection (a) shall not apply if the Secretary of State determines that a country does not assess such taxes, has a mechanism for reimbursement of such taxes, or that U.S. foreign policy interests outweigh the purposes of subsection (a). Subsection (e) provides for the issuance of regulations regarding this section. Subsection (f) provides definitions. TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMSSec. 501. Sustainability and Strengthening of Health Care Systems. This section amends the 2003 Act by adding a new title relating to sustainability and strengthening of health care systems in countries as part of overall efforts to combat HIV/AIDS. The new title also directs U.S. representatives to relevant international financial institutions to support the exemption of health expenditures from any proposed national budget caps or other limits. Sec. 502. Clerical Amendment. This section makes a clerical amendment to the 2003 Act to reflect the new title. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTEDIn compliance with clause 3(e) of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics, existing law in which no change is proposed is shown in roman): UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA ACT OF 2003AN ACT To provide assistance to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and for other purposes.Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
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