CHAPTER 83 —UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA
SUBCHAPTER I—POLICY PLANNING AND COORDINATION
SUBCHAPTER II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE PARTNERSHIPS
SUBCHAPTER III—BILATERAL EFFORTS
Part A—General Assistance and Programs
Part B—Assistance for Children and Families
SUBCHAPTER IV—AUTHORIZATION OF APPROPRIATIONS
SUBCHAPTER V—INTERNATIONAL FINANCIAL INSTITUTIONS
§7601. Findings
Congress makes the following findings:
(1) During the last 20 years, HIV/AIDS has assumed pandemic proportions, spreading from the most severely affected regions, sub-Saharan Africa and the Caribbean, to all corners of the world, and leaving an unprecedented path of death and devastation.
(2) According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), more than 65,000,000 individuals worldwide have been infected with HIV since the epidemic began, more than 25,000,000 of these individuals have lost their lives to the disease, and more than 14,000,000 children have been orphaned by the disease. HIV/AIDS is the fourth-highest cause of death in the world.
(3)(A) At the end of 2002, an estimated 42,000,000 individuals were infected with HIV or living with AIDS, of which more than 75 percent live in Africa or the Caribbean. Of these individuals, more than 3,200,000 were children under the age of 15 and more than 19,200,000 were women.
(B) Women are four times more vulnerable to infection than are men and are becoming infected at increasingly high rates, in part because many societies do not provide poor women and young girls with the social, legal, and cultural protections against high risk activities that expose them to HIV/AIDS.
(C) Women and children who are refugees or are internally displaced persons are especially vulnerable to sexual exploitation and violence, thereby increasing the possibility of HIV infection.
(4) As the leading cause of death in sub-Saharan Africa, AIDS has killed more than 19,400,000 individuals (more than 3 times the number of AIDS deaths in the rest of the world) and will claim the lives of one-quarter of the population, mostly adults, in the next decade.
(5) An estimated 2,000,000 individuals in Latin America and the Caribbean and another 7,100,000 individuals in Asia and the Pacific region are infected with HIV or living with AIDS. Infection rates are rising alarmingly in Eastern Europe (especially in the Russian Federation), Central Asia, and China.
(6) HIV/AIDS threatens personal security by affecting the health, lifespan, and productive capacity of the individual and the social cohesion and economic well-being of the family.
(7) HIV/AIDS undermines the economic security of a country and individual businesses in that country by weakening the productivity and longevity of the labor force across a broad array of economic sectors and by reducing the potential for economic growth over the long term.
(8) HIV/AIDS destabilizes communities by striking at the most mobile and educated members of society, many of whom are responsible for security at the local level and governance at the national and subnational levels as well as many teachers, health care personnel, and other community workers vital to community development and the effort to combat HIV/AIDS. In some countries the overwhelming challenges of the HIV/AIDS epidemic are accelerating the outward migration of critically important health care professionals.
(9) HIV/AIDS weakens the defenses of countries severely affected by the HIV/AIDS crisis through high infection rates among members of their military forces and voluntary peacekeeping personnel. According to UNAIDS, in sub-Saharan Africa, many military forces have infection rates as much as five times that of the civilian population.
(10) HIV/AIDS poses a serious security issue for the international community by—
(A) increasing the potential for political instability and economic devastation, particularly in those countries and regions most severely affected by the disease;
(B) decreasing the capacity to resolve conflicts through the introduction of peacekeeping forces because the environments into which these forces are introduced pose a high risk for the spread of HIV/AIDS; and
(C) increasing the vulnerability of local populations to HIV/AIDS in conflict zones from peacekeeping troops with HIV infection rates significantly higher than civilian populations.
(11) The devastation wrought by the HIV/AIDS pandemic is compounded by the prevalence of tuberculosis and malaria, particularly in developing countries where the poorest and most vulnerable members of society, including women, children, and those individuals living with HIV/AIDS, become infected. According to the World Health Organization (WHO), HIV/AIDS, tuberculosis, and malaria accounted for more than 5,700,000 deaths in 2001 and caused debilitating illnesses in millions more.
(12) Together, HIV/AIDS, tuberculosis, malaria and related diseases are undermining agricultural production throughout Africa. According to the United Nations Food and Agricultural Organization, 7,000,000 agricultural workers throughout 25 African countries have died from AIDS since 1985. Countries with poorly developed agricultural systems, which already face chronic food shortages, are the hardest hit, particularly in sub-Saharan Africa, where high HIV prevalence rates are compounding the risk of starvation for an estimated 14,400,000 people.
(13) Tuberculosis is the cause of death for one out of every three people with AIDS worldwide and is a highly communicable disease. HIV infection is the leading threat to tuberculosis control. Because HIV infection so severely weakens the immune system, individuals with HIV and latent tuberculosis infection have a 100 times greater risk of developing active tuberculosis diseases thereby increasing the risk of spreading tuberculosis to others. Tuberculosis, in turn, accelerates the onset of AIDS in individuals infected with HIV.
(14) Malaria, the most deadly of all tropical parasitic diseases, has been undergoing a dramatic resurgence in recent years due to increasing resistance of the malaria parasite to inexpensive and effective drugs. At the same time, increasing resistance of mosquitoes to standard insecticides makes control of transmission difficult to achieve. The World Health Organization estimates that between 300,000,000 and 500,000,000 new cases of malaria occur each year, and annual deaths from the disease number between 2,000,000 and 3,000,000. Persons infected with HIV are particularly vulnerable to the malaria parasite. The spread of HIV infection contributes to the difficulties of controlling resurgence of the drug resistant malaria parasite.
(15) HIV/AIDS is first and foremost a health problem. Successful strategies to stem the spread of the HIV/AIDS pandemic will require clinical medical interventions, the strengthening of health care delivery systems and infrastructure, and determined national leadership and increased budgetary allocations for the health sector in countries affected by the epidemic as well as measures to address the social and behavioral causes of the problem and its impact on families, communities, and societal sectors.
(16) Basic interventions to prevent new HIV infections and to bring care and treatment to people living with AIDS, such as voluntary counseling and testing and mother-to-child transmission programs, are achieving meaningful results and are cost-effective. The challenge is to expand these interventions from a pilot program basis to a national basis in a coherent and sustainable manner.
(17) Appropriate treatment of individuals with HIV/AIDS can prolong the lives of such individuals, preserve their families, prevent children from becoming orphans, and increase productivity of such individuals by allowing them to lead active lives and reduce the need for costly hospitalization for treatment of opportunistic infections caused by HIV.
(18) Nongovernmental organizations, including faith-based organizations, with experience in health care and HIV/AIDS counseling, have proven effective in combating the HIV/AIDS pandemic and can be a resource in assisting indigenous organizations in severely affected countries in their efforts to provide treatment and care for individuals infected with HIV/AIDS.
(19) Faith-based organizations are making an important contribution to HIV prevention and AIDS treatment programs around the world. Successful HIV prevention programs in Uganda, Jamaica, and elsewhere have included local churches and faith-based groups in efforts to promote behavior changes to prevent HIV, to reduce stigma associated with HIV infection, to treat those afflicted with the disease, and to care for orphans. The Catholic Church alone currently cares for one in four people being treated for AIDS worldwide. Faith-based organizations possess infrastructure, experience, and knowledge that will be needed to carry out these programs in the future and should be an integral part of United States efforts.
(20)(A) Uganda has experienced the most significant decline in HIV rates of any country in Africa, including a decrease among pregnant women from 20.6 percent in 1991 to 7.9 percent in 2000.
(B) Uganda made this remarkable turnaround because President Yoweri Museveni spoke out early, breaking long-standing cultural taboos, and changed widespread perceptions about the disease. His leadership stands as a model for ways political leaders in Africa and other developing countries can mobilize their nations, including civic organizations, professional associations, religious institutions, business and labor to combat HIV/AIDS.
(C) Uganda's successful AIDS treatment and prevention program is referred to as the ABC model: "Abstain, Be faithful, use Condoms", in order of priority. Jamaica, Zambia, Ethiopia and Senegal have also successfully used the ABC model. Beginning in 1986, Uganda brought about a fundamental change in sexual behavior by developing a low-cost program with the message: "Stop having multiple partners. Be faithful. Teenagers, wait until you are married before you begin sex.".
(D) By 1995, 95 percent of Ugandans were reporting either one or zero sexual partners in the past year, and the proportion of sexually active youth declined significantly from the late 1980s to the mid-1990s. The greatest percentage decline in HIV infections and the greatest degree of behavioral change occurred in those 15 to 19 years old. Uganda's success shows that behavior change, through the use of the ABC model, is a very successful way to prevent the spread of HIV.
(21) The magnitude and scope of the HIV/AIDS crisis demands a comprehensive, long-term, international response focused upon addressing the causes, reducing the spread, and ameliorating the consequences of the HIV/AIDS pandemic, including—
(A) prevention and education, care and treatment, basic and applied research, and training of health care workers, particularly at the community and provincial levels, and other community workers and leaders needed to cope with the range of consequences of the HIV/AIDS crisis;
(B) development of health care infrastructure and delivery systems through cooperative and coordinated public efforts and public and private partnerships;
(C) development and implementation of national and community-based multisector strategies that address the impact of HIV/AIDS on the individual, family, community, and nation and increase the participation of at-risk populations in programs designed to encourage behavioral and social change and reduce the stigma associated with HIV/AIDS; and
(D) coordination of efforts between international organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), national governments, and private sector organizations, including faith-based organizations.
(22) The United States has the capacity to lead and enhance the effectiveness of the international community's response by—
(A) providing substantial financial resources, technical expertise, and training, particularly of health care personnel and community workers and leaders;
(B) promoting vaccine and microbicide research and the development of new treatment protocols in the public and commercial pharmaceutical research sectors;
(C) making available pharmaceuticals and diagnostics for HIV/AIDS therapy;
(D) encouraging governments and faith-based and community-based organizations to adopt policies that treat HIV/AIDS as a multisectoral public health problem affecting not only health but other areas such as agriculture, education, the economy, the family and society, and assisting them to develop and implement programs corresponding to these needs;
(E) promoting healthy lifestyles, including abstinence, delaying sexual debut, monogamy, marriage, faithfulness, use of condoms, and avoiding substance abuse; and
(F) encouraging active involvement of the private sector, including businesses, pharmaceutical and biotechnology companies, the medical and scientific communities, charitable foundations, private and voluntary organizations and nongovernmental organizations, faith-based organizations, community-based organizations, and other nonprofit entities.
(23) Prostitution and other sexual victimization are degrading to women and children and it should be the policy of the United States to eradicate such practices. The sex industry, the trafficking of individuals into such industry, and sexual violence are additional causes of and factors in the spread of the HIV/AIDS epidemic. One in nine South Africans is living with AIDS, and sexual assault is rampant, at a victimization rate of one in three women. Meanwhile in Cambodia, as many as 40 percent of prostitutes are infected with HIV and the country has the highest rate of increase of HIV infection in all of Southeast Asia. Victims of coercive sexual encounters do not get to make choices about their sexual activities.
(24) Strong coordination must exist among the various agencies of the United States to ensure effective and efficient use of financial and technical resources within the United States Government with respect to the provision of international HIV/AIDS assistance.
(25) In his address to Congress on January 28, 2003, the President announced the Administration's intention to embark on a five-year emergency plan for AIDS relief, to confront HIV/AIDS with the goals of preventing 7,000,000 new HIV/AIDS infections, treating at least 2,000,000 people with life-extending drugs, and providing humane care for millions of people suffering from HIV/AIDS, and for children orphaned by HIV/AIDS.
(26) In this address to Congress, the President stated the following: "Today, on the continent of Africa, nearly 30,000,000 people have the AIDS virus—including 3,000,000 children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4,000,000 require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims—only 50,000—are receiving the medicine they need.".
(27) Furthermore, the President focused on care and treatment of HIV/AIDS in his address to Congress, stating the following: "Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says, 'We have no medicines. Many hospitals tell people, you've got AIDS, we can't help you. Go home and die.' In an age of miraculous medicines, no person should have to hear those words. AIDS can be prevented. Anti-retroviral drugs can extend life for many years * * * Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many.".
(28) Finally, the President stated that "[w]e have confronted, and will continue to confront, HIV/AIDS in our own country", proposing now that the United States should lead the world in sparing innocent people from a plague of nature, and asking Congress "to commit $15,000,000,000 over the next five years, including nearly $10,000,000,000 in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean".
(29) On May 27, 2003, the President signed this chapter into law, launching the largest international public health program of its kind ever created.
(30) Between 2003 and 2008, the United States, through the President's Emergency Plan for AIDS Relief (PEPFAR) and in conjunction with other bilateral programs and the multilateral Global Fund has helped to—
(A) provide antiretroviral therapy for over 1,900,000 people;
(B) ensure that over 150,000 infants, most of whom would have likely been infected with HIV during pregnancy or childbirth, were not infected; and
(C) provide palliative care and HIV prevention assistance to millions of other people.
(31) While United States leadership in the battles against HIV/AIDS, tuberculosis, and malaria has had an enormous impact, these diseases continue to take a terrible toll on the human race.
(32) According to the 2007 AIDS Epidemic Update of the Joint United Nations Programme on HIV/AIDS (UNAIDS)—
(A) an estimated 2,100,000 people died of AIDS-related causes in 2007; and
(B) an estimated 2,500,000 people were newly infected with HIV during that year.
(33) According to the World Health Organization, malaria kills more than 1,000,000 people per year, 70 percent of whom are children under 5 years of age.
(34) According to the World Health Organization, 1/3 of the world's population is infected with the tuberculosis bacterium, and tuberculosis is 1 of the greatest infectious causes of death of adults worldwide, killing 1,600,000 people per year.
(35) Efforts to promote abstinence, fidelity, the correct and consistent use of condoms, the delay of sexual debut, and the reduction of concurrent sexual partners represent important elements of strategies to prevent the transmission of HIV/AIDS.
(36) According to UNAIDS—
(A) women and girls make up nearly 60 percent of persons in sub-Saharan Africa who are HIV positive;
(B) women and girls are more biologically, economically, and socially vulnerable to HIV infection; and
(C) gender issues are critical components in the effort to prevent HIV/AIDS and to care for those affected by the disease.
(37) Children who have lost a parent to HIV/AIDS, who are otherwise directly affected by the disease, or who live in areas of high HIV prevalence may be vulnerable to the disease or its socioeconomic effects.
(38) Lack of health capacity, including insufficient personnel and inadequate infrastructure, in sub-Saharan Africa and other regions of the world is a critical barrier that limits the effectiveness of efforts to combat HIV/AIDS, tuberculosis, and malaria, and to achieve other global health goals.
(39) On March 30, 2007, the Institute of Medicine of the National Academies released a report entitled "PEPFAR Implementation: Progress and Promise", which found that budget allocations setting percentage levels for spending on prevention, care, and treatment and for certain subsets of activities within the prevention category—
(A) have "adversely affected implementation of the U.S. Global AIDS Initiative";
(B) have inhibited comprehensive, integrated, evidence based approaches;
(C) "have been counterproductive";
(D) "may have been helpful initially in ensuring a balance of attention to activities within the 4 categories of prevention, treatment, care, and orphans and vulnerable children";
(E) "have also limited PEPFAR's ability to tailor its activities in each country to the local epidemic and to coordinate with the level of activities in the countries' national plans"; and
(F) should be removed by Congress and replaced with more appropriate mechanisms that—
(i) "ensure accountability for results from Country Teams to the U.S. Global AIDS Coordinator and to Congress"; and
(ii) "ensure that spending is directly linked to and commensurate with necessary efforts to achieve both country and overall performance targets for prevention, treatment, care, and orphans and vulnerable children".
(40) The United States Government has endorsed the principles of harmonization in coordinating efforts to combat HIV/AIDS commonly referred to as the "Three Ones", which includes—
(A) 1 agreed HIV/AIDS action framework that provides the basis for coordination of the work of all partners;
(B) 1 national HIV/AIDS coordinating authority, with a broadbased multisectoral mandate; and
(C) 1 agreed HIV/AIDS country-level monitoring and evaluating system.
(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, of April 26–27, 2001 (referred to in this chapter as the "Abuja Declaration"), the Heads of State and Government of the Organization of African Unity (OAU)—
(A) declared that they would "place the fight against HIV/AIDS at the forefront and as the highest priority issue in our respective national development plans";
(B) committed "TO TAKE PERSONAL RESPONSIBILITY AND PROVIDE LEADERSHIP for the activities of the National AIDS Commissions/Councils";
(C) resolved "to lead from the front the battle against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by personally ensuring that such bodies were properly convened in mobilizing our societies as a whole and providing focus for unified national policymaking and programme implementation, ensuring coordination of all sectors at all levels with a gender perspective and respect for human rights, particularly to ensure equal rights for people living with HIV/AIDS"; and
(D) pledged "to set a target of allocating at least 15% of our annual budget to the improvement of the health sector".
(
Editorial Notes
References in Text
This chapter, referred to in pars. (29) and (41), was in the original "this Act", meaning
Amendments
2008—Pars. (29) to (41).
Statutory Notes and Related Subsidiaries
Short Title of 2018 Amendment
Short Title of 2013 Amendment
Short Title of 2008 Amendment
Short Title
Executive Documents
Delegation of Functions
For delegation of functions of President under this chapter, except for functions set forth in
§7602. Definitions
In this chapter:
(1) AIDS
The term "AIDS" means the acquired immune deficiency syndrome.
(2) Appropriate congressional committees
The term "appropriate congressional committees" means the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives, the Committee on Appropriations of the Senate, and the Committee on Appropriations of the House of Representatives.
(3) Global AIDS Coordinator
The term "Global AIDS Coordinator" means the Coordinator of United States Government Activities to Combat HIV/AIDS Globally.
(4) Global Fund
The term "Global Fund" means the public-private partnership known as the Global Fund to Fight AIDS, Tuberculosis and Malaria established pursuant to Article 80 of the Swiss Civil Code.
(5) HIV
The term "HIV" means the human immunodeficiency virus, the pathogen that causes AIDS.
(6) HIV/AIDS
The term "HIV/AIDS" means, with respect to an individual, an individual who is infected with HIV or living with AIDS.
(7) Impact evaluation research
The term "impact evaluation research" means the application of research methods and statistical analysis to measure the extent to which change in a population-based outcome can be attributed to program intervention instead of other environmental factors.
(8) Operations research
The term "operations research" means the application of social science research methods, statistical analysis, and other appropriate scientific methods to judge, compare, and improve policies and program outcomes, from the earliest stages of defining and designing programs through their development and implementation, with the objective of the rapid dissemination of conclusions and concrete impact on programming.
(9) Paraprofessional
The term "paraprofessional" means an individual who is trained and employed as a health agent for the provision of basic assistance in the identification, prevention, or treatment of illness or disability.
(10) Partner government
The term "partner government" means a government with which the United States is working to provide assistance to combat HIV/AIDS, tuberculosis, or malaria on behalf of people living within the jurisdiction of such government.
(11) Program monitoring
The term "program monitoring" means the collection, analysis, and use of routine program data to determine—
(A) how well a program is carried out; and
(B) how much the program costs.
(12) Relevant executive branch agencies
The term "relevant executive branch agencies" means the Department of State, the United States Agency for International Development, and any other department or agency of the United States that participates in international HIV/AIDS activities pursuant to the authorities of such department or agency or the Foreign Assistance Act of 1961 [
(
Editorial Notes
References in Text
This chapter, referred to in text, was in the original "this Act", meaning
The Foreign Assistance Act of 1961, referred to in par. (12), is
Amendments
2008—
§7603. Purpose
The purpose of this chapter is to strengthen and enhance United States leadership and the effectiveness of the United States response to the HIV/AIDS, tuberculosis, and malaria pandemics and other related and preventable infectious diseases as part of the overall United States health and development agenda by—
(1) establishing comprehensive, coordinated, and integrated 5-year, global strategies to combat HIV/AIDS, tuberculosis, and malaria by—
(A) building on progress and successes to date;
(B) improving harmonization of United States efforts with national strategies of partner governments and other public and private entities; and
(C) emphasizing capacity building initiatives in order to promote a transition toward greater sustainability through the support of country-driven efforts;
(2) providing increased resources for bilateral and multilateral efforts to fight HIV/AIDS, tuberculosis, and malaria as integrated components of United States development assistance;
(3) intensifying efforts to—
(A) prevent HIV infection;
(B) ensure the continued support for, and expanded access to, treatment and care programs;
(C) enhance the effectiveness of prevention, treatment, and care programs; and
(D) address the particular vulnerabilities of girls and women;
(4) encouraging the expansion of private sector efforts and expanding public-private sector partnerships to combat HIV/AIDS, tuberculosis, and malaria;
(5) reinforcing efforts to—
(A) develop safe and effective vaccines, microbicides, and other prevention and treatment technologies; and
(B) improve diagnostics capabilities for HIV/AIDS, tuberculosis, and malaria; and
(6) helping partner countries to—
(A) strengthen health systems;
(B) expand health workforce; and
(C) address infrastructural weaknesses.
(
Editorial Notes
References in Text
This chapter, referred to in text, was in the original "this Act", meaning
Amendments
2008—
§7604. Authority to consolidate and combine reports
With respect to the reports required by this chapter to be submitted by the President, to ensure an efficient use of resources, the President may, in his discretion and notwithstanding any other provision of this chapter, consolidate or combine any of these reports, except for the report required by
(
Editorial Notes
References in Text
This chapter, referred to in text, was in the original "this Act", meaning
Amendments
2008—
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
SUBCHAPTER I—POLICY PLANNING AND COORDINATION
§7611. Development of a comprehensive, five-year, global strategy
(a) Strategy
The President shall establish a comprehensive, integrated, 5-year strategy to expand and improve efforts to combat global HIV/AIDS. This strategy shall—
(1) further strengthen the capability of the United States to be an effective leader of the international campaign against this disease and strengthen the capacities of nations experiencing HIV/AIDS epidemics to combat this disease;
(2) maintain sufficient flexibility and remain responsive to—
(A) changes in the epidemic;
(B) challenges facing partner countries in developing and implementing an effective national response; and
(C) evidence-based improvements and innovations in the prevention, care, and treatment of HIV/AIDS;
(3) situate United States efforts to combat HIV/AIDS, tuberculosis, and malaria within the broader United States global health and development agenda, establishing a roadmap to link investments in specific disease programs to the broader goals of strengthening health systems and infrastructure and to integrate and coordinate HIV/AIDS, tuberculosis, or malaria programs with other health or development programs, as appropriate;
(4) provide a plan to—
(A) prevent 12,000,000 new HIV infections worldwide;
(B) support—
(i) the increase in the number of individuals with HIV/AIDS receiving antiretroviral treatment above the goal established under
(ii) additional treatment through coordinated multilateral efforts;
(C) support care for 12,000,000 individuals infected with or affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children affected by HIV/AIDS, with an emphasis on promoting a comprehensive, coordinated system of services to be integrated throughout the continuum of care;
(D) help partner countries in the effort to achieve goals of 80 percent access to counseling, testing, and treatment to prevent the transmission of HIV from mother to child, emphasizing a continuum of care model;
(E) help partner countries to provide care and treatment services to children with HIV in proportion to their percentage within the HIV-infected population in each country;
(F) promote preservice training for health professionals designed to strengthen the capacity of institutions to develop and implement policies for training health workers to combat HIV/AIDS, tuberculosis, and malaria;
(G) equip teachers with skills needed for HIV/AIDS prevention and support for persons with, or affected by, HIV/AIDS;
(H) provide and share best practices for combating HIV/AIDS with health professionals;
(I) promote pediatric HIV/AIDS training for physicians, nurses, and other health care workers, through public-private partnerships if possible, including through the designation, if appropriate, of centers of excellence for training in pediatric HIV/AIDS prevention, care, and treatment in partner countries; and
(J) help partner countries to train and support retention of health care professionals and paraprofessionals, with the target of training and retaining at least 140,000 new health care professionals and paraprofessionals with an emphasis on training and in country deployment of critically needed doctors and nurses and to strengthen capacities in developing countries, especially in sub-Saharan Africa, to deliver primary health care with the objective of helping countries achieve staffing levels of at least 2.3 doctors, nurses, and midwives per 1,000 population, as called for by the World Health Organization;
(5) include multisectoral approaches and specific strategies to treat individuals infected with HIV/AIDS and to prevent the further transmission of HIV infections, with a particular focus on the needs of families with children (including the prevention of mother-to-child transmission), women, young people, orphans, and vulnerable children;
(6) establish a timetable with annual global treatment targets with country-level benchmarks for antiretroviral treatment;
(7) expand the integration of timely and relevant research within the prevention, care, and treatment of HIV/AIDS;
(8) include a plan for program monitoring, operations research, and impact evaluation and for the dissemination of a best practices report to highlight findings;
(9) support the in-country or intra-regional training, preferably through public-private partnerships, of scientific investigators, managers, and other staff who are capable of promoting the systematic uptake of clinical research findings and other evidence-based interventions into routine practice, with the goal of improving the quality, effectiveness, and local leadership of HIV/AIDS health care;
(10) expand and accelerate research on and development of HIV/AIDS prevention methods for women, including enhancing inter-agency collaboration, staffing, and organizational infrastructure dedicated to microbicide research;
(11) provide for consultation with local leaders and officials to develop prevention strategies and programs that are tailored to the unique needs of each country and community and targeted particularly toward those most at risk of acquiring HIV infection;
(12) make the reduction of HIV/AIDS behavioral risks a priority of all prevention efforts by—
(A) promoting abstinence from sexual activity and encouraging monogamy and faithfulness;
(B) encouraging the correct and consistent use of male and female condoms and increasing the availability of, and access to, these commodities;
(C) promoting the delay of sexual debut and the reduction of multiple concurrent sexual partners;
(D) promoting education for discordant couples (where an individual is infected with HIV and the other individual is uninfected or whose status is unknown) about safer sex practices;
(E) promoting voluntary counseling and testing, addiction therapy, and other prevention and treatment tools for illicit injection drug users and other substance abusers;
(F) educating men and boys about the risks of procuring sex commercially and about the need to end violent behavior toward women and girls;
(G) supporting partner country and community efforts to identify and address social, economic, or cultural factors, such as migration, urbanization, conflict, gender-based violence, lack of empowerment for women, and transportation patterns, which directly contribute to the transmission of HIV;
(H) supporting comprehensive programs to promote alternative livelihoods, safety, and social reintegration strategies for commercial sex workers and their families;
(I) promoting cooperation with law enforcement to prosecute offenders of trafficking, rape, and sexual assault crimes with the goal of eliminating such crimes; and
(J) working to eliminate rape, gender-based violence, sexual assault, and the sexual exploitation of women and children;
(13) include programs to reduce the transmission of HIV, particularly addressing the heightened vulnerabilities of women and girls to HIV in many countries; and
(14) support other important means of preventing or reducing the transmission of HIV, including—
(A) medical male circumcision;
(B) the maintenance of a safe blood supply;
(C) promoting universal precautions in formal and informal health care settings;
(D) educating the public to recognize and to avoid risks to contract HIV through blood exposures during formal and informal health care and cosmetic services;
(E) investigating suspected nosocomial infections to identify and stop further nosocomial transmission; and
(F) other mechanisms to reduce the transmission of HIV;
(15) increase support for prevention of mother-to-child transmission;
(16) build capacity within the public health sector of developing countries by improving health systems and public health infrastructure and developing indicators to measure changes in broader public health sector capabilities;
(17) increase the coordination of HIV/AIDS programs with development programs;
(18) provide a framework for expanding or developing existing or new country or regional programs, including—
(A) drafting compacts or other agreements, as appropriate;
(B) establishing criteria and objectives for such compacts and agreements; and
(C) promoting sustainability;
(19) provide a plan for national and regional priorities for resource distribution and a global investment plan by region;
(20) provide a plan to address the immediate and ongoing needs of women and girls, which—
(A) addresses the vulnerabilities that contribute to their elevated risk of infection;
(B) includes specific goals and targets to address these factors;
(C) provides clear guidance to field missions to integrate gender across prevention, care, and treatment programs;
(D) sets forth gender-specific indicators to monitor progress on outcomes and impacts of gender programs;
(E) supports efforts in countries in which women or orphans lack inheritance rights and other fundamental protections to promote the passage, implementation, and enforcement of such laws;
(F) supports life skills training, especially among women and girls, with the goal of reducing vulnerabilities to HIV/AIDS;
(G) addresses and prevents gender-based violence; and
(H) addresses the posttraumatic and psychosocial consequences and provides postexposure prophylaxis protecting against HIV infection to victims of gender-based violence and rape;
(21) provide a plan to—
(A) determine the local factors that may put men and boys at elevated risk of contracting or transmitting HIV;
(B) address male norms and behaviors to reduce these risks, including by reducing alcohol abuse;
(C) promote responsible male behavior; and
(D) promote male participation and leadership at the community level in efforts to promote HIV prevention, reduce stigma, promote participation in voluntary counseling and testing, and provide care, treatment, and support for persons with HIV/AIDS;
(22) provide a plan to address the vulnerabilities and needs of orphans and children who are vulnerable to, or affected by, HIV/AIDS;
(23) encourage partner countries to develop health care curricula and promote access to training tailored to individuals receiving services through, or exiting from, existing programs geared to orphans and vulnerable children;
(24) provide a framework to work with international actors and partner countries toward universal access to HIV/AIDS prevention, treatment, and care programs, recognizing that prevention is of particular importance;
(25) enhance the coordination of United States bilateral efforts to combat global HIV/AIDS with other major public and private entities;
(26) enhance the attention given to the national strategic HIV/AIDS plans of countries receiving United States assistance by—
(A) reviewing the planning and programmatic decisions associated with that assistance; and
(B) helping to strengthen such national strategies, if necessary;
(27) support activities described in the Global Plan to Stop TB, including—
(A) expanding and enhancing the coverage of the Directly Observed Treatment Short-course (DOTS) in order to treat individuals infected with tuberculosis and HIV, including multi-drug resistant or extensively drug resistant tuberculosis; and
(B) improving coordination and integration of HIV/AIDS and tuberculosis programming;
(28) ensure coordination between the Global AIDS Coordinator and the Malaria Coordinator and address issues of comorbidity between HIV/AIDS and malaria; and
(29) include a longer term estimate of the projected resource needs, progress toward greater sustainability and country ownership of HIV/AIDS programs, and the anticipated role of the United States in the global effort to combat HIV/AIDS during the 10-year period beginning on October 1, 2013.
(b) Report
(1) In general
Not later than October 1, 2009, the President shall submit a report to the appropriate congressional committees that sets forth the strategy described in subsection (a).
(2) Contents
The report required under paragraph (1) shall include a discussion of the following elements:
(A) The purpose, scope, methodology, and general and specific objectives of the strategy.
(B) The problems, risks, and threats to the successful pursuit of the strategy.
(C) The desired goals, objectives, activities, and outcome-related performance measures of the strategy.
(D) A description of future costs and resources needed to carry out the strategy.
(E) A delineation of United States Government roles, responsibility, and coordination mechanisms of the strategy.
(F) A description of the strategy—
(i) to promote harmonization of United States assistance with that of other international, national, and private actors as elucidated in the "Three Ones"; and
(ii) to address existing challenges in harmonization and alignment.
(G) A description of the manner in which the strategy will—
(i) further the development and implementation of the national multisectoral strategic HIV/AIDS frameworks of partner governments; and
(ii) enhance the centrality, effectiveness, and sustainability of those national plans.
(H) A description of how the strategy will seek to achieve the specific targets described in subsection (a) and other targets, as appropriate.
(I) A description of, and rationale for, the timetable for annual global treatment targets with country-level estimates of numbers of persons in need of antiretroviral treatment, country-level benchmarks for United States support for assistance for antiretroviral treatment, and numbers of persons enrolled in antiretroviral treatment programs receiving United States support. If global benchmarks are not achieved within the reporting period, the report shall include a description of steps being taken to ensure that global benchmarks will be achieved and a detailed breakdown and justification of spending priorities in countries in which benchmarks are not being met, including a description of other donor or national support for antiretroviral treatment in the country, if appropriate.
(J) A description of how operations research is addressed in the strategy and how such research can most effectively be integrated into care, treatment, and prevention activities in order to—
(i) improve program quality and efficiency;
(ii) ascertain cost effectiveness;
(iii) ensure transparency and accountability;
(iv) assess population-based impact;
(v) disseminate findings and best practices; and
(vi) optimize delivery of services.
(K) An analysis of United States-assisted strategies to prevent the transmission of HIV/AIDS, including methodologies to promote abstinence, monogamy, faithfulness, the correct and consistent use of male and female condoms, reductions in concurrent sexual partners, and delay of sexual debut, and of intended monitoring and evaluation approaches to measure the effectiveness of prevention programs and ensure that they are targeted to appropriate audiences.
(L) Within the analysis required under subparagraph (K), an examination of additional planned means of preventing the transmission of HIV including medical male circumcision, maintenance of a safe blood supply, public education about risks to acquire HIV infection from blood exposures, promotion of universal precautions, investigation of suspected nosocomial infections and other tools.
(M) A description of efforts to assist partner country and community to identify and address social, economic, or cultural factors, such as migration, urbanization, conflict, gender-based violence, lack of empowerment for women, and transportation patterns, which directly contribute to the transmission of HIV.
(N) A description of the specific targets, goals, and strategies developed to address the needs and vulnerabilities of women and girls to HIV/AIDS, including—
(i) activities directed toward men and boys;
(ii) activities to enhance educational, microfinance, and livelihood opportunities for women and girls;
(iii) activities to promote and protect the legal empowerment of women, girls, and orphans and vulnerable children;
(iv) programs targeted toward gender-based violence and sexual coercion;
(v) strategies to meet the particular needs of adolescents;
(vi) assistance for victims of rape, sexual abuse, assault, exploitation, and trafficking; and
(vii) programs to prevent alcohol abuse.
(O) A description of strategies to address male norms and behaviors that contribute to the transmission of HIV, to promote responsible male behavior, and to promote male participation and leadership in HIV/AIDS prevention, care, treatment, and voluntary counseling and testing.
(P) A description of strategies—
(i) to address the needs of orphans and vulnerable children, including an analysis of—
(I) factors contributing to children's vulnerability to HIV/AIDS; and
(II) vulnerabilities caused by the impact of HIV/AIDS on children and their families; and
(ii) in areas of higher HIV/AIDS prevalence, to promote a community-based approach to vulnerability, maximizing community input into determining which children participate.
(Q) A description of capacity-building efforts undertaken by countries themselves, including adherents of the Abuja Declaration and an assessment of the impact of International Monetary Fund macroeconomic and fiscal policies on national and donor investments in health.
(R) A description of the strategy to—
(i) strengthen capacity building within the public health sector;
(ii) improve health care in those countries;
(iii) help countries to develop and implement national health workforce strategies;
(iv) strive to achieve goals in training, retaining, and effectively deploying health staff;
(v) promote the use of codes of conduct for ethical recruiting practices for health care workers; and
(vi) increase the sustainability of health programs.
(S) A description of the criteria for selection, objectives, methodology, and structure of compacts or other framework agreements with countries or regional organizations, including—
(i) the role of civil society;
(ii) the degree of transparency;
(iii) benchmarks for success of such compacts or agreements; and
(iv) the relationship between such compacts or agreements and the national HIV/AIDS and public health strategies and commitments of partner countries.
(T) A strategy to better coordinate HIV/AIDS assistance with nutrition and food assistance programs.
(U) A description of transnational or regional initiatives to combat regionalized epidemics in highly affected areas such as the Caribbean.
(V) A description of planned resource distribution and global investment by region.
(W) A description of coordination efforts in order to better implement the Stop TB Strategy and to address the problem of coinfection of HIV/AIDS and tuberculosis and of projected challenges or barriers to successful implementation.
(X) A description of coordination efforts to address malaria and comorbidity with malaria and HIV/AIDS.
(c) Study of progress toward achievement of policy objectives
(1) Design and budget plan for data evaluation
The Global AIDS Coordinator shall enter into a contract with the Institute of Medicine of the National Academies that provides that not later than 18 months after July 30, 2008, the Institute, in consultation with the Global AIDS Coordinator and other relevant parties representing the public and private sector, shall provide the Global AIDS Coordinator with a design plan and budget for the evaluation and collection of baseline and subsequent data to address the elements set forth in paragraph (2)(B). The Global AIDS Coordinator shall submit the budget and design plan to the appropriate congressional committees.
(2) Study
(A) In general
Not later than 4 years after July 30, 2008, the Institute of Medicine of the National Academies shall publish a study that includes—
(i) an assessment of the performance of United States-assisted global HIV/AIDS programs; and
(ii) an evaluation of the impact on health of prevention, treatment, and care efforts that are supported by United States funding, including multilateral and bilateral programs involving joint operations.
(B) Content
The study conducted under this paragraph shall include—
(i) an assessment of progress toward prevention, treatment, and care targets;
(ii) an assessment of the effects on health systems, including on the financing and management of health systems and the quality of service delivery and staffing;
(iii) an assessment of efforts to address gender-specific aspects of HIV/AIDS, including gender related constraints to accessing services and addressing underlying social and economic vulnerabilities of women and men;
(iv) an evaluation of the impact of treatment and care programs on 5-year survival rates, drug adherence, and the emergence of drug resistance;
(v) an evaluation of the impact of prevention programs on HIV incidence in relevant population groups;
(vi) an evaluation of the impact on child health and welfare of interventions authorized under this chapter on behalf of orphans and vulnerable children;
(vii) an evaluation of the impact of programs and activities authorized in this chapter on child mortality; and
(viii) recommendations for improving the programs referred to in subparagraph (A)(i).
(C) Methodologies
Assessments and impact evaluations conducted under the study shall utilize sound statistical methods and techniques for the behavioral sciences, including random assignment methodologies as feasible. Qualitative data on process variables should be used for assessments and impact evaluations, wherever possible.
(3) Contract authority
The Institute of Medicine may enter into contracts or cooperative agreements or award grants to conduct the study under paragraph (2).
(4) Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out the study under this subsection.
(d) Comptroller General report
(1) Report required
Not later than 3 years after July 30, 2008, the Comptroller General of the United States shall submit a report on the global HIV/AIDS programs of the United States to the appropriate congressional committees.
(2) Contents
The report required under paragraph (1) shall include—
(A) a description and assessment of the monitoring and evaluation practices and policies in place for these programs;
(B) an assessment of coordination within Federal agencies involved in these programs, examining both internal coordination within these programs and integration with the larger global health and development agenda of the United States;
(C) an assessment of procurement policies and practices within these programs;
(D) an assessment of harmonization with national government HIV/AIDS and public health strategies as well as other international efforts;
(E) an assessment of the impact of global HIV/AIDS funding and programs on other United States global health programming; and
(F) recommendations for improving the global HIV/AIDS programs of the United States.
(e) Best practices report
(1) In general
Not later than 1 year after July 30, 2008, and annually thereafter, the Global AIDS Coordinator shall publish a best practices report that highlights the programs receiving financial assistance from the United States that have the potential for replication or adaption, particularly at a low cost, across global AIDS programs, including those that focus on both generalized and localized epidemics.
(2) Dissemination of findings
(A) Publication on Internet website
The Global AIDS Coordinator shall disseminate the full findings of the annual best practices report on the Internet website of the Office of the Global AIDS Coordinator.
(B) Dissemination guidance
The Global AIDS Coordinator shall develop guidance to ensure timely submission and dissemination of significant information regarding best practices with respect to global AIDS programs.
(f) Inspectors General
(1) Oversight plan
(A) Development
The Inspectors General of the Department of State and Broadcasting Board of Governors, the Department of Health and Human Services, and the United States Agency for International Development shall jointly develop coordinated annual plans for oversight activity in each of the fiscal years 2009 through March 25 of fiscal year 2025, with regard to the programs authorized under this chapter and
(B) Contents
The plans developed under subparagraph (A) shall include a schedule for financial audits, inspections, and performance reviews, as appropriate.
(C) Deadline
(i) Initial plan
The first plan developed under subparagraph (A) shall be completed not later than the later of—
(I) September 1, 2008; or
(II) 60 days after July 30, 2008.
(ii) 2010 through 2013 plans
Each of the plans for fiscal years 2010 through 2013 developed under subparagraph (A) shall be completed not later than 30 days before each of the fiscal years 2010 through 2013, respectively.
(iii) 2014 plan
The plan developed under subparagraph (A) for fiscal year 2014 shall be completed not later than 60 days after December 2, 2013.
(iv) Subsequent plans
Each of the last eleven plans developed under subparagraph (A) shall be completed not later than 30 days before each of the fiscal years 2015 through 2025, respectively.
(2) Coordination
In order to avoid duplication and maximize efficiency, the Inspectors General described in paragraph (1) shall coordinate their activities with—
(A) the Government Accountability Office; and
(B) the Inspectors General of the Department of Commerce, the Department of Defense, the Department of Labor, and the Peace Corps, as appropriate, pursuant to the 2004 Memorandum of Agreement Coordinating Audit Coverage of Programs and Activities Implementing the President's Emergency Plan for AIDS Relief, or any successor agreement.
(3) Funding
The Global AIDS Coordinator and the Coordinator of the United States Government Activities to Combat Malaria Globally shall make available necessary funds not exceeding $15,000,000 during the 5-year period beginning on October 1, 2008 to the Inspectors General described in paragraph (1) for the audits, inspections, and reviews described in that paragraph.
(g) Annual study
(1) In general
Not later than September 30, 2009, and annually thereafter through March 25, 2025, the Global AIDS Coordinator shall complete a study of treatment providers that—
(A) represents a range of countries and service environments;
(B) estimates the per-patient cost of antiretroviral HIV/AIDS treatment and the care of people with HIV/AIDS not receiving antiretroviral treatment, including a comparison of the costs for equivalent services provided by programs not receiving assistance under this chapter;
(C) estimates per-patient costs across the program and in specific categories of service providers, including—
(i) urban and rural providers;
(ii) country-specific providers; and
(iii) other subcategories, as appropriate.
(2) 2013 through 2025 studies
The studies required to be submitted by September 30, 2014, and annually thereafter through March 25, 2025, shall include, in addition to the elements set forth under paragraph (1), the following elements:
(A) A plan for conducting cost studies of United States assistance under
(B) A comprehensive and harmonized expenditure analysis by partner country, including—
(i) an analysis of Global Fund and national partner spending and comparable data across United States, Global Fund, and national partner spending; or
(ii) where providing such comparable data is not currently practicable, an explanation of why it is not currently practicable, and when it will be practicable.
(3) Publication
Not later than 90 days after the completion of each study under paragraph (1), the Global AIDS Coordinator shall make the results of such study available on a publicly accessible Web site.
(4) Partner country defined
In this subsection, the term "partner country" means a country with a minimum United States Government investment of HIV/AIDS assistance of at least $5,000,000 in the prior fiscal year.
(h) Message
The Global AIDS Coordinator shall develop a message, to be prominently displayed by each program receiving funds under this chapter, that—
(1) demonstrates that the program is a commitment by citizens of the United States to the global fight against HIV/AIDS, tuberculosis, and malaria; and
(2) enhances awareness by program recipients that the program is an effort on behalf of the citizens of the United States.
(
Editorial Notes
References in Text
This chapter, referred to in subsecs. (c)(2)(B)(vi), (vii), (f)(1)(A), (g)(1)(B), and (h), was in the original "this Act", meaning
Amendments
2024—Subsec. (f)(1)(A).
Subsec. (f)(1)(C)(iv).
Subsec. (g)(1).
Subsec. (g)(2).
2018—Subsec. (f)(1)(A).
Subsec. (f)(1)(C)(iv).
Subsec. (g)(1).
Subsec. (g)(2).
2013—Subsec. (f)(1)(A).
Subsec. (f)(1)(C)(ii).
Subsec. (f)(1)(C)(iii), (iv).
Subsec. (g)(1).
Subsec. (g)(2), (3).
Subsec. (g)(4).
2008—Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsecs. (d) to (f).
Subsecs. (g), (h).
Statutory Notes and Related Subsidiaries
Change of Name
Broadcasting Board of Governors renamed United States Agency for Global Media pursuant to
Executive Documents
Delegation of Certain Authority Under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
For delegation of functions of President under this chapter to Secretary of State, see Delegation of Functions note set out under
Memorandum of President of the United States, Feb. 23, 2004, 69 F.R. 9509, provided:
Memorandum for the Secretary of State
By the authority vested in me as President by the Constitution and the laws of the United States, including
You are authorized and directed to publish this memorandum in the Federal Register.
George W. Bush.
§7612. HIV/AIDS response Coordinator
(a) Omitted
(b) Resources
Not later than 90 days after May 27, 2003, the President shall specify the necessary financial and personnel resources, from funds appropriated pursuant to the authorization of appropriations under
(c) Establishment of separate account
There is established in the general fund of the Treasury a separate account which shall be known as the "Activities to Combat HIV/AIDS Globally Fund" and which shall be administered by the Coordinator of United States Government Activities to Combat HIV/AIDS Globally. There shall be deposited into the Fund all amounts appropriated pursuant to the authorization of appropriations under
(d) Sense of Congress
It is the sense of Congress that—
(1) full-time country level coordinators, preferably with management experience, should head each HIV/AIDS country team for United States missions overseeing significant HIV/AIDS programs;
(2) foreign service nationals provide critically important services in the design and implementation of United States country-level HIV/AIDS programs and their skills and experience as public health professionals should be recognized within hiring and compensation practices; and
(3) staffing levels for United States country-level HIV/AIDS teams should be adequately maintained to fulfill oversight and other obligations of the positions.
(
Editorial Notes
References in Text
This chapter, referred to in subsec. (b), was in the original "this Act", meaning
Codification
Section is comprised of section 102 of
Amendments
2008—Subsec. (d).
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
§7612a. HIV/AIDS Working Capital Fund
(1) In furtherance of the purposes of
(2) Funds deposited during any fiscal year in the HIV/AIDS Fund shall be available without fiscal year limitation and used for pharmaceuticals and other products needed to provide care and treatment of persons with HIV/AIDS and related infections, including, but not limited to—
(A) anti-retroviral drugs;
(B) other pharmaceuticals and medical items needed to provide care and treatment to persons with HIV/AIDS and related infections;
(C) laboratory and other supplies for performing tests related to the provision of care and treatment to persons with HIV/AIDS and related infections;
(D) other medical supplies needed for the operation of HIV/AIDS treatment and care centers, including products needed in programs for the prevention of mother-to-child transmission;
(E) pharmaceuticals and health commodities needed for the provision of palliative care; and
(F) laboratory and clinical equipment, as well as equipment needed for the transportation and care of HIV/AIDS supplies, and other equipment needed to provide prevention, care and treatment of HIV/AIDS described above.
(3) There may be deposited during any fiscal year in the HIV/AIDS Fund payments for HIV/AIDS pharmaceuticals and products provided from the HIV/AIDS Fund received from applicable appropriations and funds of the United States Agency for International Development, the Department of Health and Human Services, the Department of Defense, or other Federal agencies and other sources at actual cost of the HIV/AIDS pharmaceuticals and other products, actual cost plus the additional costs of providing such HIV/AIDS pharmaceuticals and other products, or at any other price agreed to by the Coordinator or his designee.
(4) There may be deposited in the HIV/AIDS Fund payments for the loss of, or damage to, HIV/AIDS pharmaceuticals and products held in the HIV/AIDS Fund, rebates, reimbursements, refunds and other credits applicable to the operation of the HIV/AIDS Fund.
(5) At the close of each fiscal year the Coordinator may transfer out of the HIV/AIDS Fund to other HIV/AIDS programmatic areas such amounts as the Coordinator determines to be in excess of the needs of the HIV/AIDS Fund.
(6) At the close of each fiscal year the Coordinator shall submit a report to the Committees on Appropriations detailing the financial activities of the HIV/AIDS Fund, including sources of income and information regarding disbursements.
(
Editorial Notes
Codification
Section was enacted as part of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 2005, and also as part of the Consolidated Appropriations Act, 2005, and not as part of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 which comprises this chapter.
SUBCHAPTER II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE PARTNERSHIPS
§7621. Sense of Congress on public-private partnerships
(a) Findings
Congress makes the following findings:
(1) Innovative partnerships between governments and organizations in the private sector (including foundations, universities, corporations, faith-based and community-based organizations, and other nongovernmental organizations) have proliferated in recent years, particularly in the area of health.
(2) Public-private sector partnerships multiply local and international capacities to strengthen the delivery of health services in developing countries and to accelerate research for vaccines and other pharmaceutical products that are essential to combat infectious diseases decimating the populations of these countries.
(3) These partnerships maximize the unique capabilities of each sector while combining financial and other resources, scientific knowledge, and expertise toward common goals which neither the public nor the private sector can achieve alone.
(4) Sustaining existing public-private partnerships and building new ones are critical to the success of the international community's efforts to combat HIV/AIDS and other infectious diseases around the globe.
(b) Sense of Congress
It is the sense of Congress that—
(1) the sustainment and promotion of public-private partnerships should be a priority element of the strategy pursued by the United States to combat the HIV/AIDS pandemic and other global health crises; and
(2) the United States should systematically track the evolution of these partnerships and work with others in the public and private sector to profile and build upon those models that are most effective.
(
§7622. Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria
(a) Findings; sense of Congress
(1) Findings
Congress makes the following findings:
(A) The establishment of the Global Fund in January 2002 is consistent with the general principles for an international AIDS trust fund first outlined by Congress in the Global AIDS and Tuberculosis Relief Act of 2000 (
(B) The Global Fund is an innovative financing mechanism which—
(i) has made progress in many areas in combating HIV/AIDS, tuberculosis, and malaria; and
(ii) represents the multilateral component of this chapter, extending United States efforts to more than 130 countries around the world.
(C) The Global Fund and United States bilateral assistance programs—
(i) are demonstrating increasingly effective coordination, with each possessing certain comparative advantages in the fight against HIV/AIDS, tuberculosis, and malaria; and
(ii) often work most effectively in concert with each other.
(D) The United States Government—
(i) is the largest supporter of the Global Fund in terms of resources and technical support;
(ii) made the founding contribution to the Global Fund; and
(iii) is fully committed to the success of the Global Fund as a multilateral public-private partnership.
(2) Sense of Congress
It is the sense of Congress that—
(A) transparency and accountability are crucial to the long-term success and viability of the Global Fund;
(B) the Global Fund has made significant progress toward addressing concerns raised by the Government Accountability Office by—
(i) improving risk assessment and risk management capabilities;
(ii) providing clearer guidance for and oversight of Local Fund Agents; and
(iii) strengthening the Office of the Inspector General for the Global Fund;
(C) the provision of sufficient resources and authority to the Office of the Inspector General for the Global Fund to ensure that office has the staff and independence necessary to carry out its mandate will be a measure of the commitment of the Global Fund to transparency and accountability;
(D) regular, publicly published financial, programmatic, and reporting audits of the Fund, its grantees, and Local Fund Agents are also important benchmarks of transparency;
(E) the Global Fund should establish and maintain a system to track—
(i) the amount of funds disbursed to each subrecipient on the grant's fiscal cycle; and
(ii) the distribution of resources, by grant and principal recipient, for prevention, care, treatment, drug and commodity purchases, and other purposes;
(F) relevant national authorities in recipient countries should exempt from duties and taxes all products financed by Global Fund grants and procured by any principal recipient or subrecipient for the purpose of carrying out such grants;
(G) the Global Fund, UNAIDS, and the Global AIDS Coordinator should work together to standardize program indicators wherever possible;
(H) for purposes of evaluating total amounts of funds contributed to the Global Fund under subsection (d)(4)(A)(i), the timetable for evaluations of contributions from sources other than the United States should take into account the fiscal calendars of other major contributors; and
(I) the Global Fund should not support activities involving the "Affordable Medicines Facility-Malaria" or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.
(b) Authority for United States participation
(1) United States participation
The United States is hereby authorized to participate in the Global Fund.
(2) Privileges and immunities
The Global Fund shall be considered a public international organization for purposes of
(3) Statement of policy
The United States Government regards the imposition by recipient countries of taxes or tariffs on goods or services provided by the Global Fund, which are supported through public and private donations, including the substantial contribution of the American people, as inappropriate and inconsistent with standards of good governance. The Global AIDS Coordinator or other representatives of the United States Government shall work with the Global Fund to dissuade governments from imposing such duties, tariffs, or taxes.
(c) Reports to Congress
Not later than 1 year after May 27, 2003, and annually thereafter for the duration of the Global Fund, the President shall submit to the appropriate congressional committees a report on the Global Fund, including contributions pledged to, contributions (including donations from the private sector) received by, and projects funded by the Global Fund, and the mechanisms established for transparency and accountability in the grant-making process.
(d) United States financial participation
(1) Authorization of appropriations
In addition to any other funds authorized to be appropriated for bilateral or multilateral HIV/AIDS, tuberculosis, or malaria programs, of the amounts authorized to be appropriated under
(2) Availability of funds
Amounts appropriated under paragraph (1) are authorized to remain available until expended.
(3) Reprogramming of fiscal year 2001 funds
Funds made available for fiscal year 2001 under section 141 of the Global AIDS and Tuberculosis Relief Act of 2000 [
(A) are authorized to remain available until expended; and
(B) shall be transferred to, merged with, and made available for the same purposes as, funds made available for fiscal years 2004 through 2008 under paragraph (1).
(4) Limitation
(A)(i) At any time during fiscal years 2004 through March 25 of fiscal year 2025, no United States contribution to the Global Fund may cause the total amount of United States Government contributions to the Global Fund to exceed 33 percent of the total amount of funds contributed to the Global Fund from all sources. Contributions to the Global Fund from the International Bank for Reconstruction and Development and the International Monetary Fund shall not be considered in determining compliance with this paragraph.
(ii) If, at any time during any of the fiscal years 2009 through March 25 of fiscal year 2025, the President determines that the Global Fund has provided assistance to a country, the government of which the Secretary of State has determined, for purposes of section 4605(j)(1) 2 of title 50, has repeatedly provided support for acts of international terrorism, then the United States shall withhold from its contribution for the next fiscal year an amount equal to the amount expended by the Fund to the government of each such country.
(iii) If at any time the President determines that the expenses of the Governing, Administrative, and Advisory Bodies (including the Partnership Forum, the Foundation Board, the Secretariat, and the Technical Review Board) of the Global Fund exceed 10 percent of the total expenditures of the Fund for any 2-year period, the United States shall withhold from its contribution for the next fiscal year an amount equal the to the average annual amount expended by the Fund for such 2-year period for the expenses of the Governing, Administrative, and Advisory Bodies in excess of 10 percent of the total expenditures of the Fund.
(iv) The President may waive the application of clause (iii) if the President determines that extraordinary circumstances warrant such a waiver. No waiver under this clause may be for any period that exceeds 1 year.
(v) If, at any time during any of the fiscal years 2004 through 2008, the President determines that the salary of any individual employed by the Global Fund exceeds the salary of the Vice President of the United States (as determined under
(B)(i) Any amount made available that is withheld by reason of subparagraph (A)(i) shall be contributed to the Global Fund as soon as practicable, subject to subparagraph (A)(i), after additional contributions to the Global Fund are made from other sources.
(ii) Any amount made available that is withheld by reason of clause (ii) or (iii) of subparagraph (A) is authorized to be made available to carry out
(iii) Notwithstanding clause (i), after July 31 of each of the fiscal years 2009 through 2024 and March 25 of fiscal year 2025, any amount made available that is withheld by reason of subparagraph (A)(i) is authorized to be made available to carry out
(C)(i) The President may suspend the application of subparagraph (A) with respect to a fiscal year if the President determines that an international health emergency threatens the national security interests of the United States.
(ii) The President shall notify the Committee on Foreign Affairs of the House of Representatives and the Committee on Foreign Relations of the Senate not less than 5 days before making a determination under clause (i) with respect to the application of subparagraph (A)(i) and shall include in the notification—
(I) a justification as to why increased United States Government contributions to the Global Fund is preferable to increased United States assistance to combat HIV/AIDS, tuberculosis, and malaria on a bilateral basis; and
(II) an explanation as to why other government donors to the Global Fund are unable to provide adequate contributions to the Fund.
(5) Withholding funds
Notwithstanding any other provision of this chapter, 20 percent of the amounts appropriated pursuant to this chapter for a contribution to support the Global Fund for each of the fiscal years 2010 through 2024 and for fiscal year 2025 through March 25 of such fiscal year shall be withheld from obligation to the Global Fund until the Secretary of State certifies to the appropriate congressional committees that the Global Fund—
(A) has established an evaluation framework for the performance of Local Fund Agents (referred to in this paragraph as "LFAs");
(B) is undertaking a systematic assessment of the performance of LFAs;
(C) has adopted, and is implementing, a policy to publish on a publicly available Web site in an open, machine readable format—
(i) grant performance reviews;
(ii) all reports of the Inspector General of the Global Fund, in a manner that is consistent with the Policy for Disclosure of Reports of the Inspector General, approved at the 16th Meeting of the Board of the Global Fund;
(iii) decision points of the Board of the Global Fund;
(iv) reports from Board committees to the Board; and
(v) a regular collection, analysis, and reporting of performance data and funding of grants of the Global Fund, which covers all principal recipients and all subrecipients on the fiscal cycle of each grant, and includes the distribution of resources, by grant and principal recipient and subrecipient, for prevention, care, treatment, drugs, and commodities purchase, and other purposes as practicable;
(D) is maintaining an independent, well-staffed Office of the Inspector General that—
(i) reports directly to the Board of the Global Fund; and
(ii) compiles regular, publicly published audits, in an open, machine readable format, of financial, programmatic, and reporting aspects of the Global Fund, its grantees, and LFAs;
(E) has established, and is reporting publicly, in an open, machine readable format, on, standard indicators for all program areas;
(F) has established a methodology to track and is publicly reporting on—
(i) all subrecipients and the amount of funds disbursed to each subrecipient on the grant's fiscal cycle;
(ii) all principal recipients and subrecipients and the amount of funds disbursed to each principal recipient and subrecipient on the fiscal cycle of the grant;
(iii) expenditure data—
(I) tracked by principal recipients and subrecipients by program area, where practicable, prevention, care, and treatment and reported in a format that allows comparison with other funding streams in each country; or
(II) if such expenditure data is not available, outlay or disbursement data, and an explanation of progress made toward providing such expenditure data; and
(iv) high-quality grant performance evaluations measuring inputs, outputs, and outcomes, as appropriate, with the goal of achieving outcome reporting;
(G) has published an annual report on a publicly available Web site in an open, machine readable format, that includes—
(i) a list of all countries imposing import duties and internal taxes on any goods or services financed by the Global Fund;
(ii) a description of the types of goods or services on which the import duties and internal taxes are levied;
(iii) the total cost of the import duties and internal taxes;
(iv) recovered import duties or internal taxes; and
(v) the status of country status-agreements;
(H) through its Secretariat, has taken meaningful steps to prevent national authorities in recipient countries from imposing taxes or tariffs on goods or services provided by the Fund;
(I) is maintaining its status as a financing institution focused on programs directly related to HIV/AIDS, malaria, and tuberculosis;
(J) is maintaining and making progress on—
(i) sustaining its multisectoral approach, through country coordinating mechanisms; and
(ii) the implementation of grants, as reflected in the proportion of resources allocated to different sectors, including governments, civil society, and faith- and community-based organizations; and
(K) has established procedures providing access by the Office of Inspector General of the Department of State and Broadcasting Board of Governors, as cognizant Inspector General, and the Inspector General of the Health and Human Services and the Inspector General of the United States Agency for International Development, to Global Fund financial data, and other information relevant to United States contributions (as determined by the Inspector General in consultation with the Global AIDS Coordinator).
(6) Summaries of Board decisions and United States positions
Following each meeting of the Board of the Global Fund, the Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall report on the public website of the Coordinator a summary of Board decisions and how the United States Government voted and its positions on such decisions.
(e) Interagency technical review panel
(1) Establishment
The Coordinator of United States Government Activities to Combat HIV/AIDS Globally, established in
(2) Duties
The interagency technical review panel shall serve as a "shadow" panel to the Global Fund by—
(A) periodically reviewing all proposals received by the Global Fund; and
(B) providing guidance to the United States persons who are representatives on the panels, committees, and boards of the Global Fund, on the technical efficacy, suitability, and appropriateness of the proposals, and ensuring that such persons are fully informed of technical inadequacies or other aspects of the proposals that are inconsistent with the purposes of this chapter or any other Act relating to the provision of foreign assistance in the area of AIDS.
(3) Membership
The interagency technical review panel shall consist of qualified medical and development experts who are officers or employees of the Department of Health and Human Services, the Department of State, and the United States Agency for International Development.
(4) Chair
The Coordinator referred to in paragraph (1) shall chair the interagency technical review panel.
(f) Monitoring by Comptroller General
(1) Monitoring
The Comptroller General shall monitor and evaluate projects funded by the Global Fund.
(2) Report
The Comptroller General shall on a biennial basis shall prepare and submit to the appropriate congressional committees a report that contains the results of the monitoring and evaluation described in paragraph (1) for the preceding 2-year period.
(g) Provision of information to Congress
The Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall make available to the Congress the following documents within 30 days of a request by the Congress for such documents:
(1) All financial and accounting statements for the Global Fund and the Activities to Combat HIV/AIDS Globally Fund, including administrative and grantee statements.
(2) Reports provided to the Global Fund and the Activities to Combat HIV/AIDS Globally Fund by organizations contracted to audit recipients of funds.
(3) Project proposals submitted by applicants for funding from the Global Fund and the Activities to Combat HIV/AIDS Globally Fund, but which were not funded.
(4) Progress reports submitted to the Global Fund and the Activities to Combat HIV/AIDS Globally Fund by grantees.
(h) Sense of the Congress regarding encouragement of private contributions to the Global Fund
It is the sense of the Congress that the President should—
(1) conduct an outreach campaign that is designed to—
(A) inform the public of the existence of—
(i) the Global Fund; and
(ii) any entity that will accept private contributions intended for use by the Global Fund; and
(B) encourage private contributions to the Global Fund; and
(2) encourage private contributions intended for use by the Global Fund by—
(A) establishing and operating an Internet website, and publishing information about the website; and
(B) making public service announcements on radio and television.
(
Editorial Notes
References in Text
The Global AIDS and Tuberculosis Relief Act of 2000, referred to in subsec. (a)(1)(A), is
This chapter, referred to in subsecs. (a)(1)(B)(ii), (d)(5), and (e)(2)(B), was in the original a reference to this Act, meaning
Amendments
2024—Subsec. (d)(4)(A)(i), (ii).
Subsec. (d)(4)(B)(iii).
Subsec. (d)(5).
2018—Subsec. (d)(4)(A)(i).
Subsec. (d)(4)(A)(ii).
Subsec. (d)(4)(A)(vi).
Subsec. (d)(4)(B)(ii).
Subsec. (d)(4)(B)(iii), (iv).
Subsec. (d)(5).
2013—Subsec. (d)(4)(A)(i).
Subsec. (d)(4)(A)(ii).
Subsec. (d)(4)(A)(vi).
Subsec. (d)(4)(B).
Subsec. (d)(4)(B)(ii).
Subsec. (d)(4)(B)(iv).
Subsec. (d)(5).
Subsec. (d)(5)(C).
Subsec. (d)(5)(C)(v).
Subsec. (d)(5)(D)(ii).
Subsec. (d)(5)(E).
Subsec. (d)(5)(F)(ii) to (iv).
Subsec. (d)(5)(G).
2008—Subsec. (a).
Subsec. (b)(3).
Subsec. (d)(1).
Subsec. (d)(4)(A)(i).
Subsec. (d)(4)(A)(ii).
Subsec. (d)(4)(A)(vi).
Subsec. (d)(4)(B)(iv).
Subsec. (d)(4)(C)(ii).
Subsec. (d)(5), (6).
2004—Subsec. (d)(4)(A)(vi).
Subsec. (d)(4)(B)(iv).
Statutory Notes and Related Subsidiaries
Change of Name
Broadcasting Board of Governors renamed United States Agency for Global Media pursuant to
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
2 See References in Text note below.
§7623. Combating HIV/AIDS, tuberculosis, and malaria by strengthening health policies and health systems of partner countries
(a) Statement of policy
It shall be the policy of the United States Government—
(1) to invest appropriate resources authorized under this chapter—
(A) to carry out activities to strengthen HIV/AIDS, tuberculosis, and malaria health policies and health systems; and
(B) to provide workforce training and capacity-building consistent with the goals and objectives of this chapter; and
(2) to support the development of a sound policy environment in partner countries to increase the ability of such countries—
(A) to maximize utilization of health care resources from donor countries;
(B) to increase national investments in health and education and maximize the effectiveness of such investments;
(C) to improve national HIV/AIDS, tuberculosis, and malaria strategies;
(D) to deliver evidence-based services in an effective and efficient manner; and
(E) to reduce barriers that prevent recipients of services from achieving maximum benefit from such services.
(b) Assistance to improve public finance management systems
(1) In general
Consistent with the authority under
(2) Authorization of appropriations
Of the amounts authorized to be appropriated under
(c) Plan required
The Global AIDS Coordinator, in collaboration with the Administrator of the United States Agency for International Development (USAID), shall develop and implement a plan to combat HIV/AIDS by strengthening health policies and health systems of partner countries as part of USAID's "Health Systems 2020" project. Recognizing that human and institutional capacity form the core of any health care system that can sustain the fight against HIV/AIDS, tuberculosis, and malaria, the plan shall include a strategy to encourage postsecondary educational institutions in partner countries, particularly in Africa, in collaboration with United States postsecondary educational institutions, including historically black colleges and universities, to develop such human and institutional capacity and in the process further build their capacity to sustain the fight against these diseases.
(
Editorial Notes
References in Text
This chapter, referred to in subsec. (a)(1), was in the original "this Act", meaning
§7624. Facilitating vaccine development
(a) Technical assistance for developing countries
The Administrator of the United States Agency for International Development, utilizing public-private partners, as appropriate, and working in coordination with other international development agencies, is authorized to strengthen the capacity of developing countries' governmental institutions to—
(1) collect evidence for informed decision-making and introduction of new vaccines, including potential HIV/AIDS, tuberculosis, and malaria vaccines, if such vaccines are determined to be safe and effective;
(2) review protocols for clinical trials and impact studies and improve the implementation of clinical trials; and
(3) ensure adequate supply chain and delivery systems.
(b) Advanced market commitments
(1) Purpose
The purpose of this subsection is to improve global health by requiring the United States to participate in negotiations for advance market commitments for the development of future vaccines, including potential vaccines for HIV/AIDS, tuberculosis, and malaria.
(2) Negotiation requirement
The Secretary of the Treasury shall enter into negotiations with the appropriate officials of the International Bank of Reconstruction and Development (World Bank) and the GAVI Alliance, the member nations of such entities, and other interested parties to establish advanced market commitments to purchase vaccines to combat HIV/AIDS, tuberculosis, malaria, and other related infectious diseases.
(3) Requirements
In negotiating the United States participation in programs for advanced market commitments, the Secretary of the Treasury shall take into account whether programs for advance market commitments include—
(A) legally binding contracts for product purchase that include a fair market price for up to a maximum number of treatments, creating a strong market incentive;
(B) clearly defined and transparent rules of program participation for qualified developers and suppliers of the product;
(C) clearly defined requirements for eligible vaccines to ensure that they are safe and effective and can be delivered in developing country contexts;
(D) dispute settlement mechanisms; and
(E) sufficient flexibility to enable the contracts to be adjusted in accord with new information related to projected market size and other factors while still maintaining the purchase commitment at a fair price.
(4) Report
Not later than 1 year after July 30, 2008—
(A) the Secretary of the Treasury shall submit a report to the appropriate congressional committees on the status of the United States negotiations to participate in programs for the advanced market commitments under this subsection; and
(B) the President shall produce a comprehensive report, written by a study group of qualified professionals from relevant Federal agencies and initiatives, nongovernmental organizations, and industry representatives, that sets forth a coordinated strategy to accelerate development of vaccines for infectious diseases, such as HIV/AIDS, malaria, and tuberculosis, which includes—
(i) initiatives to create economic incentives for the research, development, and manufacturing of vaccines for HIV/AIDS, tuberculosis, malaria, and other infectious diseases;
(ii) an expansion of public-private partnerships and the leveraging of resources from other countries and the private sector; and
(iii) efforts to maximize United States capabilities to support clinical trials of vaccines in developing countries and to address the challenges of delivering vaccines in developing countries to minimize delays in access once vaccines are available.
(
Editorial Notes
Codification
Section was enacted as part of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, and not as part of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 which comprises this chapter.
SUBCHAPTER III—BILATERAL EFFORTS
Part A—General Assistance and Programs
§7631. Assistance to combat HIV/AIDS
(a) Omitted
(b) Authorization of appropriations
(1) In general
In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (
(2) Availability of funds
Amounts appropriated pursuant to paragraph (1) are authorized to remain available until expended.
(3) Allocation of funds
Of the amount authorized to be appropriated by paragraph (1) for the fiscal years 2009 through 2013, such sums as may be necessary are authorized to be appropriated to carry out section 104A(d)(4) of the Foreign Assistance Act of 1961 (as added by subsection (a)) [
(c) Food and nutritional support
(1) In general
As indicated in the report produced by the Institute of Medicine, entitled "PEPFAR Implementation: Progress and Promise", inadequate caloric intake has been clearly identified as a principal reason for failure of clinical response to antiretroviral therapy. In recognition of the impact of malnutrition as a clinical health issue for many persons living with HIV/AIDS that is often associated with health and economic impacts on these individuals and their families, the Global AIDS Coordinator and the Administrator of the United States Agency for International Development shall—
(A) follow World Health Organization guidelines for HIV/AIDS food and nutrition services;
(B) integrate nutrition programs with HIV/AIDS activities through effective linkages among the health, agricultural, and livelihood sectors and establish additional services in circumstances in which referrals are inadequate or impossible;
(C) provide, as a component of care and treatment programs for persons with HIV/AIDS, food and nutritional support to individuals infected with, and affected by, HIV/AIDS who meet established criteria for nutritional support (including clinically malnourished children and adults, and pregnant and lactating women in programs in need of supplemental support), including—
(i) anthropometric and dietary assessment;
(ii) counseling; and
(iii) therapeutic and supplementary feeding;
(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
(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 [
(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).
(e) Limitation
No funds made available to carry out this chapter, or any amendment made by this chapter, may be used to promote or advocate the legalization or practice of prostitution or sex trafficking. Nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and, when proven effective, microbicides.
(f) Limitation
No funds made available to carry out this chapter, or any amendment made by this chapter, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking, except that this subsection shall not apply to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Health Organization, the International AIDS Vaccine Initiative or to any United Nations agency.
(g) Sense of Congress relating to food assistance for individuals living with HIV/AIDS
(1) Findings
Congress finds the following:
(A) The United States provides more than 60 percent of all food assistance worldwide.
(B) According to the United Nations World Food Program and other United Nations agencies, food insecurity of individuals infected or living with HIV/AIDS is a major problem in countries with large populations of such individuals, particularly in African countries.
(C) Although the United States is willing to provide food assistance to these countries in need, a few of the countries object to part or all of the assistance because of fears of benign genetic modifications to the foods.
(D) Healthy and nutritious foods for individuals infected or living with HIV/AIDS are an important complement to HIV/AIDS medicines for such individuals.
(E) Individuals infected with HIV have higher nutritional requirements than individuals who are not infected with HIV, particularly with respect to the need for protein. Also, there is evidence to suggest that the full benefit of therapy to treat HIV/AIDS may not be achieved in individuals who are malnourished, particularly in pregnant and lactating women.
(2) Sense of Congress
It is therefore the sense of Congress that United States food assistance should be accepted by countries with large populations of individuals infected or living with HIV/AIDS, particularly African countries, in order to help feed such individuals.
(
Editorial Notes
References in Text
The Foreign Assistance Act of 1961, referred to in subsec. (b)(1), is
This chapter, referred to in subsecs. (d) to (f), was in the original "this Act", meaning
The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, referred to in subsec. (d), is
Codification
Section is comprised of section 301 of
Constitutionality
For information regarding the constitutionality of certain provisions of this section, see the Table of Laws Held Unconstitutional in Whole or in Part by the Supreme Court on the Constitution Annotated website, constitution.congress.gov.
Amendments
2008—Subsec. (b)(1), (3).
Subsec. (c).
"(1) integrate nutrition programs with HIV/AIDS activities, generally;
"(2) provide, as a component of an anti-retroviral therapy program, support for food and nutrition to individuals infected with and affected by HIV/AIDS; and
"(3) provide support for food and nutrition for children affected by HIV/AIDS and to communities and households caring for children affected by HIV/AIDS."
Subsec. (d).
2004—Subsec. (f).
§7631a. United States Agency for International Development
(1) In general
The Administrator of the United States Agency for International Development, in coordination with the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, may facilitate availability and accessibility of microbicides, provided that such pharmaceuticals are approved, tentatively approved, or otherwise authorized for use by—
(A) the Food and Drug Administration;
(B) a stringent regulatory agency acceptable to the Secretary of Health and Human Services; or
(C) a quality assurance mechanism acceptable to the Secretary of Health and Human Services.
(2) Authorization of appropriations
Of the amounts authorized to be appropriated under
(
Editorial Notes
Codification
Section was enacted as part of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, and not as part of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 which comprises this chapter.
§7632. Authorization of appropriations to combat tuberculosis
(1) In general
In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (
(2) Availability of funds
Amounts appropriated pursuant to the authorization of appropriations under paragraph (1) are authorized to remain available until expended.
(3) Transfer of prior year funds
Unobligated balances of funds made available for fiscal year 2001, 2002, or 2003 under section 104(c)(7) of the Foreign Assistance Act of 1961 (
(
Editorial Notes
References in Text
The Foreign Assistance Act of 1961, referred to in par. (1), is
Amendments
2008—Par. (1).
Par. (3).
1 So in original. The period probably should not appear.
§7633. Assistance to combat malaria
(a) Omitted
(b) Authorization of appropriations
(1) In general
In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (
(2) Availability of funds
Amounts appropriated pursuant to paragraph (1) are authorized to remain available until expended.
(3) Transfer of prior year funds
Unobligated balances of funds made available for fiscal year 2001, 2002, or 2003 under section 104(c) of the Foreign Assistance Act of 1961 (
(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 2 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 chapter;
(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.
(
Editorial Notes
References in Text
The Foreign Assistance Act of 1961, referred to in subsec. (b)(1), is
This chapter, referred to in subsec. (d)(5), was in the original "this Act", meaning
Codification
Section is comprised of section 303 of
Amendments
2008—Subsec. (b)(1).
Subsec. (b)(3).
Subsecs. (c), (d).
1 So in original. Probably should be followed by a second closing parenthesis.
2 So in original. Probably should be followed by "the".
§7634. Malaria response Coordinator
(a) In general
There is established within the United States Agency for International Development a Coordinator of United States Government Activities to Combat Malaria Globally (referred to in this section as the "Malaria Coordinator"), who shall be appointed by the President.
(b) Authorities
The Malaria Coordinator, acting through nongovernmental organizations (including faith-based and community-based organizations), partner country finance, health, and other relevant ministries, and relevant executive branch agencies as may be necessary and appropriate to carry out this section, is authorized to—
(1) operate internationally to carry out prevention, care, treatment, support, capacity development, and other activities to reduce the prevalence, mortality, and incidence of malaria;
(2) provide grants to, and enter into contracts and cooperative agreements with, nongovernmental organizations (including faith-based organizations) to carry out this section; and
(3) transfer and allocate executive branch agency funds that have been appropriated for the purposes described in paragraphs (1) and (2).
(c) Duties
(1) In general
The Malaria Coordinator has primary responsibility for the oversight and coordination of all resources and international activities of the United States Government relating to efforts to combat malaria.
(2) Specific duties
The Malaria Coordinator shall—
(A) facilitate program and policy coordination of antimalarial efforts among relevant executive branch agencies and nongovernmental organizations by auditing, monitoring, and evaluating such programs;
(B) ensure that each relevant executive branch agency undertakes antimalarial programs primarily in those areas in which the agency has the greatest expertise, technical capability, and potential for success;
(C) coordinate relevant executive branch agency activities in the field of malaria prevention and treatment;
(D) coordinate planning, implementation, and evaluation with the Global AIDS Coordinator in countries in which both programs have a significant presence;
(E) coordinate with national governments, international agencies, civil society, and the private sector; and
(F) establish due diligence criteria for all recipients of funds appropriated by the Federal Government for malaria assistance.
(d) Assistance for the World Health Organization
In carrying out this section, the President may provide financial assistance to the Roll Back Malaria Partnership of the World Health Organization to improve the capacity of countries with high rates of malaria and other affected countries to implement comprehensive malaria control programs.
(e) Coordination of assistance efforts
In carrying out this section and in accordance with
(1) relevant executive branch agencies, including—
(A) the Department of State (including the Office of the Global AIDS Coordinator);
(B) the Department of Health and Human Services;
(C) the Department of Defense; and
(D) the Office of the United States Trade Representative;
(2) relevant multilateral institutions, including—
(A) the World Health Organization;
(B) the United Nations Children's Fund;
(C) the United Nations Development Programme;
(D) the Global Fund;
(E) the World Bank; and
(F) the Roll Back Malaria Partnership;
(3) program delivery and efforts to lift barriers that would impede effective and comprehensive malaria control programs; and
(4) partner or recipient country governments and national entities including universities and civil society organizations (including faith- and community-based organizations).
(f) Research
To carry out this section, the Malaria Coordinator, in accordance with
(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 chapter. Such activities shall complement, rather than duplicate, the work of the World Health Organization.
(h) Annual report
(1) Submission
Not later than 1 year after July 30, 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.
(
Editorial Notes
References in Text
This chapter, referred to in subsecs. (f) and (g), was in the original "this Act", meaning
Amendments
2008—
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
§7635. Report on treatment activities by relevant executive branch agencies
(a) In general
Not later than 15 months after May 27, 2003, the President shall submit to appropriate congressional committees a report on the programs and activities of the relevant executive branch agencies that are directed to the treatment of individuals in foreign countries infected with HIV or living with AIDS.
(b) Report elements
The report shall include—
(1) a description of the activities of relevant executive branch agencies with respect to—
(A) the treatment of opportunistic infections;
(B) the use of antiretrovirals;
(C) the status of research into successful treatment protocols for individuals in the developing world;
(D) technical assistance and training of local health care workers (in countries affected by the pandemic) to administer antiretrovirals, manage side effects, and monitor patients' viral loads and immune status;
(E) the status of strategies to promote sustainability of HIV/AIDS pharmaceuticals (including antiretrovirals) and the effects of drug resistance on HIV/AIDS patients; and
(F) the status of appropriate law enforcement officials working to ensure that HIV/AIDS pharmaceutical treatment is not diminished through illegal counterfeiting and black market sales of such pharmaceuticals;
(2) information on existing pilot projects, including a discussion of why a given population was selected, the number of people treated, the cost of treatment, the mechanisms established to ensure that treatment is being administered effectively and safely, and plans for scaling up pilot projects (including projected timelines and required resources); and
(3) an explanation of how those activities relate to efforts to prevent the transmission of the HIV infection.
(
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
§7636. Study on illegal diversions of prescription drugs
Not later than 180 days after May 27, 2003, the Secretary of Health and Human Services, in coordination with other agencies, shall submit a report to the Congress that includes the following:
(1) A thorough accounting of evidence indicating illegal diversion into the United States of prescription drugs donated or sold for humanitarian efforts, and an estimate of the extent of such diversion.
(2) Recommendations to increase the administrative and enforcement powers of the United States to identify, monitor, and prevent the illegal diversion into the United States of prescription drugs donated or sold for humanitarian efforts.
(3) Recommendations and guidelines to advise and provide technical assistance to developing countries on how to implement a program that minimizes diversion into the United States of prescription drugs donated or sold for humanitarian efforts.
(
Part B—Assistance for Women, Children, and Families
§7651. Findings
Congress makes the following findings:
(1) Approximately 2,000 children around the world are infected each day with HIV through mother-to-child transmission. Transmission can occur during pregnancy, labor, and delivery or through breast feeding. Over 90 percent of these cases are in developing nations with little or no access to public health facilities.
(2) Mother-to-child transmission is largely preventable with the proper application of pharmaceuticals, therapies, and other public health interventions.
(3) Certain antiretroviral drugs reduce mother-to-child transmission by nearly 50 percent. Universal availability of this drug could prevent up to 400,000 infections per year and dramatically reduce the number of AIDS-related deaths.
(4) At the United Nations Special Session on HIV/AIDS in June 2001, the United States committed to the specific goals with respect to the prevention of mother-to-child transmission, including the goals of reducing the proportion of infants infected with HIV by 20 percent by the year 2005 and by 50 percent by the year 2010, as specified in the Declaration of Commitment on HIV/AIDS adopted by the United Nations General Assembly at the Special Session.
(5) Several United States Government agencies including the United States Agency for International Development and the Centers for Disease Control are already supporting programs to prevent mother-to-child transmission in resource-poor nations and have the capacity to expand these programs rapidly by working closely with foreign governments and nongovernmental organizations.
(6) Efforts to prevent mother-to-child transmission can provide the basis for a broader response that includes care and treatment of mothers, fathers, and other family members who are infected with HIV or living with AIDS.
(7) HIV/AIDS has devastated the lives of countless children and families across the globe. Since the epidemic began, an estimated 13,200,000 children under the age of 15 have been orphaned by AIDS, that is they have lost their mother or both parents to the disease. The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that this number will double by the year 2010.
(8) HIV/AIDS also targets young people between the ages of 15 to 24, particularly young women, many of whom carry the burden of caring for family members living with HIV/AIDS. An estimated 10,300,000 young people are now living with HIV/AIDS. One-half of all new infections are occurring among this age group.
(
§7652. Policy and requirements
(a) Policy
The United States Government's response to the global HIV/AIDS pandemic should place high priority on the prevention of mother-to-child transmission, the care and treatment of family members and caregivers, and the care of children orphaned by AIDS. To the maximum extent possible, the United States Government should seek to leverage its funds by seeking matching contributions from the private sector, other national governments, and international organizations.
(b) Requirements
The 5-year United States Government strategy required by
(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 chapter 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 chapter and the goal of achieving universal use of such regimes as soon as possible.
(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 chapter 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 July 30, 2008, 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 chapter are administered;
(D) 3 members representing organizations implementing prevention of mother-to-child transmission activities under this chapter;
(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 chapter are administered.
(3) Duties of Panel
The Panel shall—
(A) assess the effectiveness of current activities in reaching the target described in subsection (b)(1);
(B) review scientific evidence related to the provision of mother-to-child transmission prevention services, including programmatic data and data from clinical trials;
(C) review and assess ways in which the Office of the United States Global AIDS Coordinator collaborates with international and multilateral entities on efforts to prevent mother-to-child transmission of HIV in affected countries;
(D) identify barriers and challenges to increasing access to mother-to-child transmission prevention services and evaluate potential mechanisms to alleviate those barriers and challenges;
(E) identify the extent to which stigma has hindered pregnant women from obtaining HIV counseling and testing or returning for results, and provide recommendations to address such stigma and its effects;
(F) identify opportunities to improve linkages between mother-to-child transmission prevention services and care and treatment programs; and
(G) recommend specific activities to facilitate reaching the target described in subsection (b)(1).
(4) Report
(A) In general
Not later than 1 year after the date on which the Panel is first convened, the Panel shall submit a report containing a detailed statement of the recommendations, findings, and conclusions of the Panel to the appropriate congressional committees.
(B) Availability
The report submitted under subparagraph (A) shall be made available to the public.
(C) Consideration by Coordinator
The Coordinator shall—
(i) consider any recommendations contained in the report submitted under subparagraph (A); and
(ii) include in the annual report required under
(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).
(
Editorial Notes
References in Text
This chapter, referred to in subsecs. (b)(2), (6) and (c)(1), (2), was in the original "this Act", meaning
Amendments
2008—Subsec. (b)(1) to (6).
"(1) provide for meeting or exceeding the goal to reduce the rate of mother-to-child transmission of HIV by 20 percent by 2005 and by 50 percent by 2010;
"(2) include programs to make available testing and treatment to HIV-positive women and their family members, including drug treatment and therapies to prevent mother-to-child transmission; and
"(3) expand programs designed to care for children orphaned by AIDS."
Subsec. (c).
§7653. Annual reports on prevention of mother-to-child transmission of the HIV infection
(a) In general
Not later than 1 year after May 27, 2003, and annually thereafter for a period of 10 years, the President shall submit to appropriate congressional committees a report on the activities of relevant executive branch agencies during the reporting period to assist in the prevention of mother-to-child transmission of the HIV infection.
(b) Report elements
Each report shall include—
(1) a statement of whether or not all relevant executive branch agencies have met the goal described in
(2) a description of efforts made by the relevant executive branch agencies to expand those activities, including—
(A) information on the number of sites supported for the prevention of mother-to-child transmission of the HIV infection;
(B) the specific activities supported;
(C) the number of women tested and counseled; and
(D) the number of women receiving preventative drug therapies.
(c) Reporting period defined
In this section, the term "reporting period" means, in the case of the initial report, the period since May 27, 2003, and, in the case of any subsequent report, the period since the date of submission of the most recent report.
(
Editorial Notes
Amendments
2008—Subsec. (a).
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
§7654. Pilot program of assistance for children and families affected by HIV/AIDS
(a) In general
The President, acting through the United States Agency for International Development, should establish a program of assistance that would demonstrate the feasibility of the provision of care and treatment to orphans and other children and young people affected by HIV/AIDS in foreign countries.
(b) Program requirements
The program should—
(1) build upon and be integrated into programs administered as of May 27, 2003, by the relevant executive branch agencies for children affected by HIV/AIDS;
(2) work in conjunction with indigenous community-based programs and activities, particularly those that offer proven services for children;
(3) reduce the stigma of HIV/AIDS to encourage vulnerable children infected with HIV or living with AIDS and their family members and caregivers to avail themselves of voluntary counseling and testing, and related programs, including treatments;
(4) ensure the importance of inheritance rights of women, particularly women in African countries, due to the exponential growth in the number of young widows, orphaned girls, and grandmothers becoming heads of households as a result of the HIV/AIDS pandemic;
(5) provide, in conjunction with other relevant executive branch agencies, the range of services for the care and treatment, including the provision of antiretrovirals and other necessary pharmaceuticals, of children, parents, and caregivers infected with HIV or living with AIDS;
(6) provide nutritional support and food security, and the improvement of overall family health;
(7) work with parents, caregivers, and community-based organizations to provide children with educational opportunities; and
(8) provide appropriate counseling and legal assistance for the appointment of guardians and the handling of other issues relating to the protection of children.
(c) Report
Not later than 18 months after May 27, 2003, the President should submit a report on the implementation of this section to the appropriate congressional committees. Such report should include a description of activities undertaken to carry out subsection (b)(4).
(d) Authorization of appropriations
(1) In general
In addition to amounts otherwise available for such purpose, there are authorized to be appropriated to the President, from amounts authorized to be appropriated under
(2) Availability of funds
Amounts appropriated pursuant to paragraph (1) are authorized to remain available until expended.
(
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
§7655. Pilot program on family survival partnerships
(a) Purpose
The purpose of this section is to authorize the President to establish a program, through a public-private partnership, for the provision of medical care and support services to HIV positive parents and their children identified through existing programs to prevent mother-to-child transmission of HIV in countries with or at risk for severe HIV epidemic with particular attention to resource constrained countries.
(b) Grants
(1) In general
The President is authorized to establish a program for the award of grants to eligible administrative organizations to enable such organizations to award subgrants to eligible entities to expand activities to prevent the mother-to-child transmission of HIV by providing medical care and support services to HIV infected parents and their children.
(2) Use of funds
Amounts provided under a grant awarded under paragraph (1) shall be used—
(A) to award subgrants to eligible entities to enable such entities to carry out activities described in subsection (c);
(B) for administrative support and subgrant management;
(C) for administrative data collection and reporting concerning grant activities;
(D) for the monitoring and evaluation of grant activities;
(E) for training and technical assistance for subgrantees; and
(F) to promote sustainability.
(c) Subgrants
(1) In general
An organization awarded a grant under subsection (b) shall use amounts received under the grant to award subgrants to eligible entities.
(2) Eligibility
To be eligible to receive a subgrant under paragraph (1), an entity shall—
(A) be a local health organization, an international organization, or a partnership of such organizations; and
(B) demonstrate to the awarding organization that such entity—
(i) is currently administering a proven intervention to prevent mother-to-child transmission of HIV in countries with or at risk for severe HIV epidemic with particular attention to resource constrained countries, as determined by the President;
(ii) has demonstrated support for the proposed program from relevant government entities; and
(iii) is able to provide HIV care, including antiretroviral treatment when medically indicated, to HIV positive women, men, and children with the support of the project funding.
(3) Local health and international organizations
For purposes of paragraph (2)(A)—
(A) the term "local health organization" means a public sector health system, nongovernmental organization, institution of higher education, community-based organization, or nonprofit health system that provides directly, or has a clear link with a provider for the indirect provision of, primary health care services; and
(B) the term "international organization" means—
(i) a nonprofit international entity;
(ii) an international charitable institution;
(iii) a private voluntary international entity; or
(iv) a multilateral institution.
(4) Priority requirement
In awarding subgrants under this subsection, the organization shall give priority to eligible applicants that are currently administering a program of proven intervention to HIV positive individuals to prevent mother-to-child transmission in countries with or at risk for severe HIV epidemic with particular attention to resource constrained countries, and who are currently administering a program to HIV positive women, men, and children to provide life-long care in family-centered care programs using non-Federal funds.
(5) Selection of subgrant recipients
In awarding subgrants under this subsection, the organization should—
(A) consider applicants from a range of health care settings, program approaches, and geographic locations; and
(B) if appropriate, award not less than 1 grant to an applicant to fund a national system of health care delivery to HIV positive families.
(6) Use of subgrant funds
An eligible entity awarded a subgrant under this subsection shall use subgrant funds to expand activities to prevent mother-to-child transmission of HIV by providing medical treatment and care and support services to parents and their children, which may include—
(A) providing treatment and therapy, when medically indicated, to HIV-infected women, their children, and families;
(B) the hiring and training of local personnel, including physicians, nurses, other health care providers, counselors, social workers, outreach personnel, laboratory technicians, data managers, and administrative support personnel;
(C) paying laboratory costs, including costs related to necessary equipment and diagnostic testing and monitoring (including rapid testing), complete blood counts, standard chemistries, and liver function testing for infants, children, and parents, and costs related to the purchase of necessary laboratory equipment;
(D) purchasing pharmaceuticals for HIV-related conditions, including antiretroviral therapies;
(E) funding support services, including adherence and psychosocial support services;
(F) operational support activities; and
(G) conducting community outreach and capacity building activities, including activities to raise the awareness of individuals of the program carried out by the subgrantee, other communications activities in support of the program, local advisory board functions, and transportation necessary to ensure program participation.
(d) Reports
The President shall require that each organization awarded a grant under subsection (b)(1) to submit an annual report that includes—
(1) the progress of programs funded under this section;
(2) the benchmarks of success of programs funded under this section; and
(3) recommendations of how best to proceed with the programs funded under this section upon the expiration of funding under subsection (e).
(e) Funding
There are authorized to be appropriated to the President, from amounts authorized to be appropriated under
(f) Limitation on administrative expenses
An organization shall ensure that not more than 7 percent of the amount of a grant received under this section by the organization is used for administrative expenses.
(
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under
SUBCHAPTER IV—AUTHORIZATION OF APPROPRIATIONS
§7671. Authorization of appropriations
(a) In general
There are authorized to be appropriated to the President to carry out this chapter and the amendments made by this chapter $48,000,000,000 for the 5-year period beginning on October 1, 2008.
(b) Availability
Amounts appropriated pursuant to the authorization of appropriations in subsection (a) are authorized to remain available until expended.
(c) Availability of authorizations
Authorizations of appropriations under subsection (a) shall remain available until the appropriations are made.
(
Editorial Notes
References in Text
This chapter, referred to in subsec. (a), was in the original "this Act", meaning
Amendments
2008—Subsec. (a).
§7672. Sense of Congress
(a) Increase in HIV/AIDS antiretroviral treatment
It is a sense of the Congress that an urgent priority of United States assistance programs to fight HIV/AIDS should be the rapid increase in distribution of antiretroviral treatment so that—
(1) by the end of fiscal year 2004, at least 500,000 individuals with HIV/AIDS are receiving antiretroviral treatment through United States assistance programs;
(2) by the end of fiscal year 2005, at least 1,000,000 such individuals are receiving such treatment; and
(3) by the end of fiscal year 2006, at least 2,000,000 such individuals are receiving such treatment.
(b) Effective distribution of HIV/AIDS funds
It is the sense of Congress that, of the amounts appropriated pursuant to the authorization of appropriations under
(
Editorial Notes
Amendments
2008—Subsec. (b).
"(1) 55 percent of such amounts for treatment of individuals with HIV/AIDS;
"(2) 15 percent of such amounts for palliative care of individuals with HIV/AIDS;
"(3) 20 percent of such amounts for HIV/AIDS prevention consistent with
"(4) 10 percent of such amounts".
§7673. Allocation of funds
(a) Balanced funding requirement
(1) In general
The Global AIDS Coordinator shall—
(A) provide balanced funding for prevention activities for sexual transmission of HIV/AIDS; and
(B) ensure that activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction are implemented and funded in a meaningful and equitable way in the strategy for each host country based on objective epidemiological evidence as to the source of infections and in consultation with the government of each host county 1 involved in HIV/AIDS prevention activities.
(2) Prevention strategy
(A) Establishment
In carrying out paragraph (1), the Global AIDS Coordinator shall establish an HIV sexual transmission prevention strategy governing the expenditure of funds authorized under this chapter to prevent the sexual transmission of HIV in any host country with a generalized epidemic.
(B) Report
In each host country described in subparagraph (A), if the strategy established under subparagraph (A) provides less than 50 percent of the funds described in subparagraph (A) for activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction, the Global AIDS Coordinator shall, not later than 30 days after the issuance of this strategy, report to the appropriate congressional committees on the justification for this decision.
(3) Exclusion
Programs and activities that implement or purchase new prevention technologies or modalities, such as medical male circumcision, public education about risks to acquire HIV infection from blood exposures, promoting universal precautions, investigating suspected nosocomial infections, pre-exposure pharmaceutical prophylaxis to prevent transmission of HIV, or microbicides and programs and activities that provide counseling and testing for HIV or prevent mother-to-child prevention of HIV, shall not be included in determining compliance with paragraph (2).
(4) Report
Not later than 1 year after July 30, 2008, and annually thereafter as part of the annual report required under
(A) submit a report on the implementation of paragraph (2) for the most recently concluded fiscal year to the appropriate congressional committees; and
(B) make the report described in subparagraph (A) available to the public.
(b) Orphans and vulnerable children
For fiscal years 2009 through 2024 and fiscal year 2025 through March 25 of such fiscal year, not less than 10 percent of the amounts appropriated or otherwise made available to carry out the provisions of
(c) Funding allocation
For each of the fiscal years 2009 through 2024 and for fiscal year 2025 through March 25 of such fiscal year, more than half of the amounts appropriated or otherwise made available to carry out the provisions of
(1) antiretroviral treatment for HIV/AIDS;
(2) clinical monitoring of HIV-seropositive people not in need of antiretroviral treatment;
(3) care for associated opportunistic infections;
(4) nutrition and food support for people living with HIV/AIDS; and
(5) other essential HIV/AIDS-related medical care for people living with HIV/AIDS.
(d) Treatment, prevention, and care goals
For each of the fiscal years 2009 through 2013—
(1) the treatment goal under
(2) any increase in the treatment goal under
(3) the treatment goal under
(4) the prevention and care goals established in clauses (i) and (iv) of
(
Editorial Notes
References in Text
This chapter, referred to in subsec. (a)(2)(A), was in the original "this Act", meaning
Amendments
2024—Subsec. (b).
Subsec. (c).
2018—Subsec. (b).
Subsec. (c).
2013—Subsec. (b).
Subsec. (c).
2008—Subsec. (a).
Subsec. (b).
Subsecs. (c), (d).
1 So in original. Probably should be "country".
§7674. Assistance from the United States private sector to prevent and reduce HIV/AIDS in sub-Saharan Africa
It is the sense of Congress that United States businesses should be encouraged to provide assistance to sub-Saharan African countries to prevent and reduce the incidence of HIV/AIDS in sub-Saharan Africa. In providing such assistance, United States businesses should be encouraged to consider the establishment of an HIV/AIDS Response Fund in order to provide for coordination among such businesses in the collection and distribution of the assistance to sub-Saharan African countries.
(
SUBCHAPTER V—INTERNATIONAL FINANCIAL INSTITUTIONS
§7681. Report on expansion of debt relief to non-HIPC countries
(a) In general
Not later than 90 days after May 27, 2003, the Secretary of the Treasury shall submit to Congress a report on—
(1) the options and costs associated with the expansion of debt relief provided by the Enhanced HIPC Initiative to include poor countries that were not eligible for inclusion in the Enhanced HIPC Initiative;
(2) options for burden-sharing among donor countries and multilateral institutions of costs associated with the expansion of debt relief; and
(3) options, in addition to debt relief, to ensure debt sustainability in poor countries, particularly in cases when the poor country has suffered an external economic shock or a natural disaster.
(b) Specific options to be considered
Among the options for the expansion of debt relief provided by the Enhanced HIPC Initiative, consideration should be given to making eligible for that relief poor countries for which outstanding public and publicly guaranteed debt requires annual payments in excess of 10 percent or, in the case of a country suffering a public health crisis (as defined in
(c) Enhanced HIPC Initiative defined
In this section, the term "Enhanced HIPC Initiative" means the multilateral debt initiative for heavily indebted poor countries presented in the Report of G–7 Finance Ministers on the Cologne Debt Initiative to the Cologne Economic Summit, Cologne, June 18–20, 1999.
(
§7682. Authorization of appropriations
(a) In general
There are authorized to be appropriated to the President such sums as may be necessary for the fiscal year 2004 and each fiscal year thereafter to carry out
(b) Availability of funds
Amounts appropriated pursuant to subsection (a) are authorized to remain available until expended.
(