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HR 5501 EHRFS

110th CONGRESS

2d Session

H. R. 5501

IN THE SENATE OF THE UNITED STATES

April 3, 2008

Received; read twice and referred to the Committee on Foreign Relations

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AN ACT

To authorize appropriations for fiscal years 2009 through 2013 to provide assistance to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the `Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008'.

(b) Table of Contents- The table of contents for this Act is as follows:

Sec. 1. Short title and table of contents.

Sec. 2. Findings.

Sec. 3. Definitions.

Sec. 4. Purpose.

TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of a comprehensive, five-year, global strategy.

Sec. 102. HIV/AIDS Response Coordinator.

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

Sec. 201. Sense of Congress on public-private partnerships.

Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sec. 203. Voluntary contributions to international vaccine funds.

Sec. 204. Program to facilitate availability of microbicides to prevent transmission of HIV and other diseases.

Sec. 205. Plan to combat HIV/AIDS, tuberculosis, and malaria by strengthening health policies and health systems of host countries.

TITLE III--BILATERAL EFFORTS

Subtitle A--General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.

Sec. 302. Assistance to combat tuberculosis.

Sec. 303. Assistance to combat malaria.

Sec. 304. Health care partnerships to combat HIV/AIDS.

Subtitle B--Assistance for Women, Children, and Families

Sec. 311. Policy and requirements.

Sec. 312. Annual reports on prevention of mother-to-child transmission of the HIV infection.

Sec. 313. Strategy to prevent HIV infections among women and youth.

Sec. 314. Clerical amendment.

TITLE IV--AUTHORIZATION OF APPROPRIATIONS

Sec. 401. Authorization of appropriations.

Sec. 402. Sense of Congress.

Sec. 403. Allocation of funds.

Sec. 404. Prohibition on taxation by foreign governments.

TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

Sec. 501. Sustainability and strengthening of health care systems.

Sec. 502. Clerical amendment.

SEC. 2. FINDINGS.

Section 2 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by adding at the end the following:

`(29) The HIV/AIDS pandemic continues to pose a major threat to the health of the global community, from the most severely-affected regions of sub-Saharan Africa and the Caribbean, to the emerging epidemics of Eastern Europe, Central Asia, South and Southeast Asia, and Latin America.

`(30) According to UNAIDS' 2007 global estimates, there are 33.2 million individuals with HIV/AIDS worldwide, including 2.5 million people newly-infected with HIV. Of those infected with HIV, 2.5 million are children under 15 who also account for 460,000 of the newly-infected individuals.

`(31) Sub-Saharan Africa continues to be the region most affected by the HIV/AIDS pandemic. More than 68 percent of adults and nearly 90 percent of children with HIV/AIDS live in sub-Saharan Africa, and more than 76 percent of AIDS deaths in 2007 occurred in sub-Saharan Africa.

`(32) Although sub-Saharan Africa carries the heaviest disease burden of HIV/AIDS, the HIV/AIDS pandemic continues to affect virtually every world region. While prevalence rates are relatively low in Eastern Europe, Central Asia, South and Southeast Asia, and Latin America, without effective prevention strategies, HIV prevalence rates could rise quickly in these regions.

`(33) By world region, according to UNAIDS' 2007 global estimates--

`(A) in sub-Saharan Africa, there were 22.5 million adults and children infected with HIV, up from 20.9 million in 2001, with 1.7 million new HIV infections, a 5 percent prevalence rate, and 1.6 million deaths;

`(B) in South and Southeast Asia, there were 4 million adults and children infected with HIV, up from 3.5 million in 2001, with 340,000 new HIV infections, a 0.3 percent prevalence rate, and 270,000 deaths;

`(C) in East Asia, there were 800,000 adults and children infected with HIV, up from 420,000 in 2001, with 92,000 new HIV infections, a 0.1 percent prevalence rate, and 32,000 deaths;

`(D) in Eastern and Central Europe, there were 1.6 million adults and children infected with HIV, up from 630,000 in 2001, with 150,000 new HIV infections, a 0.9 percent prevalence rate, and 55,000 deaths; and

`(E) in the Caribbean, there were 230,000 adults and children infected with HIV, up from 190,000 in 2001, with 17,000 new HIV infections, a 1 percent prevalence rate, and 11,000 deaths.

`(34) Tuberculosis is the number one killer of individuals with HIV/AIDS and is responsible for up to one-half of HIV/AIDS deaths in Africa.

`(35) The wide extent of drug resistant tuberculosis, including both multi-drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB), driven by the HIV/AIDS pandemic in sub-Saharan Africa, has hampered both HIV/AIDS and tuberculosis treatment services. The World Health Organization (WHO) has declared the prevalence of tuberculosis to be at emergency levels in sub-Saharan Africa.

`(36) Forty percent of the world's population, mostly poor, live in malarial zones, and malaria, which is highly preventable, kills more than 1 million individuals worldwide each year. Ninety percent of malaria's victims are in sub-Saharan Africa and 70 percent of malaria's victims are children under the age of 5. Additionally, hunger and malnutrition kill another 6 million individuals worldwide each year.

`(37) Assistance to combat HIV/AIDS must address the nutritional factors associated with the disease in order to be effective and sustainable. The World Food Program estimates that 6.4 million individuals affected by HIV will need nutritional support by 2008.

`(38) Women and girls continue to be vulnerable to HIV, in large part, due to gender-based cultural norms that leave many women and girls powerless to negotiate social relationships.

`(39) Women make up 50 percent of individuals infected with HIV worldwide. In sub-Saharan Africa, where the HIV/AIDS epidemic is most severe, women make up 57 percent of individuals infected with HIV, and 75 percent of young people infected with HIV in sub-Saharan Africa are young women ages 15 to 24.

`(40) Women and girls are biologically, socially, and economically more vulnerable to HIV infection. Gender disparities in the rate of HIV infection are the result of a number of factors, including the following:

`(A) Cross-generational sex with older men who are more likely to be infected with HIV, and a lack of choice regarding when and whom to marry, leading to early marriages and high rates of child marriages with older men. About one-half of all adolescent females in sub-Saharan Africa and two-thirds of adolescent females in Asia are married by age 18.

`(B) Studies show that married women and married and unmarried girls often are unable or find it difficult to negotiate the frequency and timing of sexual intercourse, ensure their partner's faithfulness, or insist on condom use. Under these circumstances, women often run the risk of being infected by husbands or male partners in societies where men in relationships have more than one partner. Behavior change is particularly important in societies in which this is a common practice.

`(C) Because young married women and girls are more likely to have unprotected sex and have more frequent sex than their unmarried peers, and women and girls who are faithful to their spouses can be placed at risk of HIV/AIDS through a husband's infidelity or prior infection, marriage is not always a guarantee against HIV infection, although it is a protective factor overall.

`(D) Social and economic inequalities based largely on gender limit access for women and girls to education and employment opportunities and prevent them from asserting their inheritance and property rights. For many women, a lack of independent economic means combines with socio-cultural practices to sustain and exacerbate their fear of abandonment, eviction, or ostracism from their homes and communities and can leave many more women trapped within relationships where they are vulnerable to HIV infection.

`(E) A lack of educational opportunities for women and girls is linked to younger sexual debut, earlier childhood marriage, earlier childbearing, decreased child survival, worsening nutrition, and increased risk of HIV infection.

`(F) High rates of gender-based violence, rape, and sexual coercion within and outside marriage contribute to high rates of HIV infection. According to the World Health Organization, between one-sixth and three-quarters of women in various countries and settings have experienced some form of physical or sexual violence since the age of 15 within or outside of marriage. Women who are unable to protect themselves from such violence are often unable to protect themselves from being infected with HIV through forced sexual contact.

`(G) Fear of domestic violence and the continuing stigma and discrimination associated with HIV/AIDS prevent many women from accessing information about HIV/AIDS, getting tested, disclosing their HIV status, accessing services to prevent mother-to-child transmission of HIV, or receiving treatment and counseling even when they already know they have been infected with HIV.

`(H) According to UNAIDS, the vulnerability of individuals involved in commercial sex acts to HIV infection is heightened by stigmatization and marginalization, limited economic options, limited access to health, social, and legal services, limited access to information and prevention means, gender-related differences and inequalities, sexual exploitation and trafficking, harmful or non-protective laws and policies, and exposure to risks associated with commercial sex acts, such as violence, substance abuse, and increased mobility.

`(I) Lack of access to basic HIV prevention information and education and lack of coordination with existing primary health care to reduce stigma and maximize coverage.

`(J) Lack of access to currently available female-controlled HIV prevention methods, such as the female condom, and lack of training on proper use of either male or female condoms.

`(K) High rates of other sexually transmitted infections and complications during pregnancies and childbirth.

`(L) An absence of functioning legal frameworks to protect women and girls and, where such frameworks exist, the lack of accountable and effective enforcement of such frameworks.

`(41) In addition to vulnerabilities to HIV infection, women in sub-Saharan Africa face a 1-in-13 chance of dying in childbirth compared to a 1-in-16 chance in least-developed countries worldwide, a 1-in-60 chance in developing countries, and a 1-in-4,100 chance in developed countries.

`(42) Due to these high maternal mortality rates and high HIV prevalence rates in certain countries, special attention is needed in these countries to help HIV-positive women safely deliver healthy babies and save women's lives.

`(43) Unprotected sex within or outside of marriage is the single greatest factor in the transmission of HIV worldwide and is responsible for 80 percent of new HIV infections in sub-Saharan Africa.

`(44) Multiple randomized controlled trials have established that male circumcision reduces a man's risk of contracting HIV by 60 percent or more. Twelve acceptability studies have found that in regions of sub-Saharan Africa where circumcision is not traditionally practiced, a majority of men want the procedure. Broader availability of male circumcision services could prevent millions of HIV infections not only in men but also in their female partners.

`(45)(A) Youth also face particular challenges in receiving services for HIV/AIDS.

`(B) Nearly one-half of all orphans who have lost one parent and two-thirds of those who have lost both parents are ages 12 to 17. These orphans are in particular need of services to protect themselves against sexually-transmitted infections, including HIV.

`(C) Research indicates that many youth benefit from full disclosure of medically accurate, age-appropriate information about abstinence, partner reduction, and condoms. Providing comprehensive information about HIV, including delay of sexual debut and the ABC model: `Abstain, Be faithful, use Condoms', and linking such information to health care can help improve awareness of safe sex practices and address the fact that only 1 in 3 young men and 1 in 5 young women ages 15 to 24 can correctly identify ways to prevent HIV infection.

`(D) Surveys indicate that no country has succeeded in fully educating more than one-half of its youth about the prevention and transmission of HIV.

`(46) According to the United Nations High Commissioner for Refugees (UNHCR), HIV/AIDS prevalence rates among refugees are generally lower than the HIV/AIDS prevalence rates for their host communities, though perceptions run counter to this fact. However, peacekeeping operations that no longer deploy HIV/AIDS-positive troops still face vulnerabilities to sexual transmission of HIV with HIV-positive individuals in refugee camps. Host countries generally do not provide HIV/AIDS prevention, treatment, and care services for refugees.

`(47) Continuing progress to reach the millions of impoverished individuals who need voluntary testing, counseling, treatment, and care for HIV/AIDS requires increased efforts to strengthen health care delivery systems and infrastructure, rebuild and expand the health care workforce, and strengthen allied and support services in countries receiving United States global HIV/AIDS assistance.

`(48) While HIV/AIDS poses the greatest health threat of modern times, it also poses the greatest development challenge for developing countries with fragile economies and weak public financial management systems that are ill equipped to shoulder the burden of this disease. International donors will have to play a critical role in providing resources for HIV/AIDS programs far into the future.

`(49) The emerging partnerships between countries most affected by HIV/AIDS and the United States must include stronger coordination between HIV/AIDS programs and other United States foreign assistance programs, and stronger collaboration with other donors in the areas of economic development and growth strategies.

`(50) The future control of HIV/AIDS demands coordination between international organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Health Organization (WHO), the World Bank and the International Monetary Fund (IMF), the international donor community, national governments, and private sector organizations, including community and faith-based organizations.

`(51) The future control of HIV/AIDS further requires effective and transparent public finance management systems in developing countries to advance the ability of such countries to manage public revenues and donor funds aimed at combating HIV/AIDS and other diseases.

`(52) The HIV/AIDS pandemic contributes to the shortage of health care personnel through loss of life and illness, unsafe working conditions, increased workloads for diminished staff, and resulting stress and burnout, while the shortage of health care personnel undermines efforts to prevent and provide care and treatment for individuals with HIV/AIDS.

`(53) The shortage of health care personnel, including doctors, nurses, pharmacists, counselors, laboratory staff, paraprofessionals, trained lay workers, and researchers is one of the leading obstacles to combating HIV/AIDS in sub-Saharan Africa.

`(54) Since 2003, important progress has been made in combating HIV/AIDS, yet there is more to be done. The number of new HIV infections is still increasing at an alarming rate. According to the United States National Institute of Allergy and Infectious Diseases, globally, for every 1 individual put on antiretroviral therapy, 6 individuals are newly infected with HIV.

`(55) The United States Government continues to be the world's leader in the fight against HIV/AIDS and the unsurpassed partner with developing countries in their efforts to control this disease.

`(56) By September 2007, the United States, through the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.), had provided services to prevent mother-to-child-transmission of HIV to women during 10 million pregnancies; provided antiretroviral prophylaxis for women during over 827,300 pregnancies; prevented an estimated 157,240 HIV infections in infants; cared for over 6.6 million individuals, including over 2.7 million orphans and vulnerable children; supported lifesaving antiretroviral therapies for approximately 1.4 million men, women, and children in sub-Saharan Africa, Asia, and the Carribean; and provided counseling and testing to over 33.7 million men, women, and children in developing countries.

`(57) These numbers were achieved because of the commitment of substantial resources and support of the United States Government to our partners on the front lines--the dedicated and committed women and men, communities, and nations who are taking control of the HIV/AIDS epidemics in their own countries.'.

SEC. 3. DEFINITIONS.

Section 3(2) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602(2)) is amended by striking `Committee on International Relations' and inserting `Committee on Foreign Affairs'.

SEC. 4. PURPOSE.

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

`SEC. 4. PURPOSE.

`The purpose of this Act is to strengthen and enhance United States global leadership and the effectiveness of the United States response to the HIV/AIDS, tuberculosis, and malaria pandemics and other related and preventable infectious diseases in developing countries by--

`(1) establishing a comprehensive, integrated five-year, global strategy to fight HIV/AIDS, tuberculosis, and malaria that encompasses a plan for continued expansion and coordination of critical programs and improved coordination among relevant executive branch agencies and between the United States and foreign governments and international organizations;

`(2) providing increased resources for United States bilateral efforts to combat HIV/AIDS, tuberculosis, and malaria, particularly for prevention, treatment, and care (including nutritional support), technical assistance and training, the strengthening of health care systems, health care workforce development, monitoring and evaluations systems, and operations research;

`(3) providing increased resources for multilateral efforts to combat HIV/AIDS, tuberculosis, and malaria;

`(4) encouraging the expansion of private sector efforts and expanding public-private sector partnerships to combat HIV/AIDS; and

`(5) intensifying efforts to support the development of vaccines, microbicides, and other prevention technologies and improved diagnostics treatment for HIV/AIDS, tuberculosis, and malaria.'.

TITLE I--POLICY PLANNING AND COORDINATION

SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL STRATEGY.

(a) Strategy- Subsection (a) of section 101 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7611) is amended--

(1) in the first sentence of the matter preceding paragraph (1), by striking `to combat' and inserting `to develop efforts further to combat';

(2) by amending paragraph (4) to read as follows:

`(4) provide that the reduction of HIV/AIDS behavioral risks shall be a priority of all prevention efforts in terms of funding, scientifically-accurate educational services, and activities by--

`(A) designing prevention strategies and programs based on sound epidemiological evidence, tailored to the unique needs of each country and community, and reaching those populations found to be most at risk for acquiring HIV infection;

`(B) promoting abstinence from sexual activity and substance abuse;

`(C) encouraging delay of sexual debut, monogamy, fidelity, and partner reduction;

`(D) promoting the effective use of male and female condoms;

`(E) promoting the use of measures to reduce the risk of HIV transmission for discordant couples (where one individual has HIV/AIDS and the other individual does not have HIV/AIDS or whose status is unknown);

`(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) promoting the rapid expansion of safe and voluntary male circumcision services;

`(H) promoting life skills training and development for children and youth;

`(I) supporting advocacy for child and youth community-based protective social services;

`(J) eradicating trafficking in persons and creating alternatives to prostitution;

`(K) promoting cooperation with law enforcement to prosecute offenders of trafficking, rape, and sexual assault crimes with the goal of eliminating such crimes;

`(L) promoting services demonstrated to be effective in reducing the transmission of HIV infection among injection drug users without increasing illicit drug use;

`(M) promoting policies and programs to end the sexual exploitation of and violence against women and children; and

`(N) promoting prevention and treatment services for men who have sex with men;';

(3) by redesignating paragraphs (5) through (10) as paragraphs (6) through (11), respectively;

(4) by inserting after paragraph (4) (as amended by paragraph (2) of this subsection) the following:

`(5) include specific plans for linkage to, and referral systems for nongovernmental organizations that implement multisectoral approaches, including faith-based and community-based organizations, for--

`(A) nutrition and food support for individuals with HIV/AIDS and affected communities;

`(B) child health services and development programs;

`(C) HIV/AIDS prevention and treatment services for injection drug users;

`(D) access to HIV/AIDS education and testing in family planning and maternal health programs supported by the United States Government; and

`(E) medical, social, and legal services for victims of violence;';

(5) by redesignating paragraphs (10) and (11) (as redesignated by paragraph (3) of this subsection) as paragraphs (11) and (12), respectively; and

(6) by inserting after paragraph (9) (as redesignated by paragraph (3) of this subsection) the following:

`(10) maximize host country capacities in training and research, particularly operations research;'.

(b) Report- Subsection (b) of such section is amended--

(1) in paragraph (1), by striking `this Act' and inserting `the Tom Lantos and Henry J. Hyde Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008'; and

(2) in paragraph (3)--

(A) by amending subparagraph (C) to read as follows:

`(C) A description of the manner in which the strategy will address the following:

`(i) The fundamental elements of prevention and education, care and treatment, including increasing access to pharmaceuticals, vaccines, and microbicides, as they become available, screening, prophylaxis, and treatment of major opportunistic infections, including tuberculosis, and increasing access to nutrition and food for individuals on antiretroviral therapies.

`(ii) The promotion of delay of sexual debut, abstinence, monogamy, fidelity, and partner reduction.

`(iii) The promotion of correct and consistent use of male and female condoms and other strategies and skills development to reduce the risk of HIV transmission.

`(iv) Increasing voluntary access to safe male circumcision services.

`(v) Life-skills training.

`(vi) The provision of information and services to encourage young people to delay sexual debut and ensure access to HIV/AIDS prevention information and services.

`(vii) Prevention of sexual violence leading to transmission of HIV and assistance for victims of violence who are at risk of HIV transmission.

`(viii) HIV/AIDS prevention, care, and treatment services for injection drug users.

`(ix) Research, including incentives for HIV vaccine development and new protocols.

`(x) Advocacy for community-based child and youth protective services.

`(xi) Training of health care workers.

`(xii) The development of health care infrastructure and delivery systems.

`(xiii) Prevention efforts for substance abusers.

`(xiv) Prevention, treatment, care, and outreach efforts for men who have sex with men.';

(B) in subparagraph (D), by adding at the end before the period the following: `, including through faith-based and other nongovernmental organizations';

(C) in subparagraph (E), by inserting `access to HIV/AIDS education and testing in family planning and maternal and child health programs supported by the United States Government and' after `the unique needs of women, including';

(D) in subparagraph (F), by inserting `(including by accessing voluntary clinical circumcision services)' after `in their sexual behavior';

(E) in subparagraph (G), by inserting `and men's' after `women's';

(F) by redesignating subparagraphs (M) through (W) as subparagraphs (N) through (X);

(G) by inserting after subparagraph (L) the following:

`(M) A description of efforts to be undertaken to strengthen the public finance management systems of selected host countries to ensure transparent, efficient, and effective management of national and donor financial investments in health.';

(H) in subparagraph (O) (as redesignated by subparagraph (F) of this paragraph), by striking `evaluating programs,' and inserting `evaluating programs to ensure medical accuracy, operations research,';

(I) in subparagraph (Q) (as redesignated by subparagraph (F) of this paragraph), by inserting `, strengthen national health care delivery systems, and increase national health workforce capacities,' after `HIV/AIDS pandemic';

(J) in subparagraph (R) (as redesignated by subparagraph (F) of this paragraph), by inserting at the end before the period the following: `, including strategies relating to agricultural development, trade and economic growth, and education';

(K) in subparagraph (T) (as redesignated by subparagraph (F) of this paragraph), by inserting `efforts of intergenerational caregivers and' after `, including';

(L) by redesignating subparagraphs (V) through (X) (as redesignated by subparagraph (F) of this paragraph), as subparagraphs (W) through (Y), respectively;

(M) by inserting after subparagraph (U) (as redesignated by subparagraph (F) of this paragraph) the following:

`(V) A plan to strengthen and implement health care workforce strategies to enable countries to increase the supply and retention of all cadres of trained professional and paraprofessional health care workers by numbers that move toward global health program needs and toward targets established by the World Health Organization, while enabling health systems to expand coverage consistent with national and international targets and goals.'; and

(N) by striking subparagraph (Y) (as redesignated by subparagraphs (F) and (L) of this paragraph) and inserting the following:

`(Y) A description of the specific strategies, developed in coordination with existing health programs, to prevent mother-to-child transmission of HIV, including the extent to which HIV-positive women and men in treatment, care, and support programs and HIV-negative women and men are counseled about methods of preventing HIV transmission and the extent to which HIV prevention methods are provided on-site or by referral in treatment, care, and support programs.

`(Z) A description of the specific strategies developed to maximize the capacity of health care providers, including faith-based and other nongovernmental organizations, and family planning providers supported by the United States Government to ensure access to necessary and comprehensive information about reducing sexual transmission of HIV among women, men, and young people, including strategies to ensure HIV/AIDS prevention training for such providers.

`(AA) A strategy to work with international and host country partners toward universal access to HIV/AIDS prevention, treatment, and care programs.'.

(c) Strategic Plan for Program Monitoring, Operations Research, and Impact Evaluation Research-

(1) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall develop a 5-year strategic plan for program monitoring, operations research, and impact evaluation research of United States HIV/AIDS, tuberculosis, and malaria programs.

(2) ELEMENTS OF PLAN- The strategic plan developed under this subsection shall include--

(A) the amount of funding provided for program monitoring, operations research, and impact evaluation research under sections 104A, 104B, and 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2, 2151b-3, and 2151b-4) and the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.) available through fiscal year 2009;

(B) strategies to--

(i) improve the efficiency, effectiveness, quality, and accessibility of services provided under the provisions of law described in subparagraph (A);

(ii) establish the cost-effectiveness of program models;

(iii) ensure the transparency and accountability of services provided under the provisions of law described in subparagraph (A);

(iv) disseminate and promote the utilization of evaluation findings, lessons, and best practices in services provided under the provisions of law described in subparagraph (A); and

(v) encourage and evaluate innovative service models and strategies to optimize the delivery of care, treatment, and prevention programs financed by the United States Government;

(C) priorities for program monitoring, operations research, and impact evaluation research and a time line for completion of activities associated with such priorities; and

(D) other information that the Coordinator determines to be necessary.

(3) CONSULTATION- In developing the strategic plan under this subsection and implementing, disseminating, and promoting the use of program monitoring, operations research, and impact evaluation research, the Coordinator shall consult with representatives of relevant executive branch agencies, other appropriate executive branch agencies, multilateral institutions involved in providing HIV/AIDS assistance, nongovernmental organizations involved in implementing HIV/AIDS programs, and the governments of host countries.

(4) DEFINITIONS- In this subsection--

(A) the terms `program monitoring', `operations research', and `impact evaluation research', have the meanings given such terms in section 104A(d)(4)(B) of the Foreign Assistance Act of 1961 (as added by section 301(a)(4)(C) of this Act); and

(B) the term `relevant executive branch agencies' has the meaning given the term in section 3 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602).

SEC. 102. HIV/AIDS RESPONSE COORDINATOR.

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

(1) in subparagraph (A)--

(A) in the matter preceding clause (i), by inserting `, host country finance, health, and other relevant ministries' after `community-based organizations)'; and

(B) in clause (iii), by inserting `and host country finance, health, and other relevant ministries' after `community-based organizations)'; and

(2) in subparagraph (B)(ii)--

(A) by striking subclauses (IV) and (V) and inserting the following:

`(IV) Establishing an interagency working group on HIV/AIDS that is comprised of, but not limited to, representatives from the United States Agency for International Development, the Department of Health and Human Services (including the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration), the Department of Labor, the Department of Agriculture, the Millennium Challenge Corporation, the Department of Defense, and the Office of the Coordinator of United States Government Activities to Combat Malaria Globally, for the purposes of coordination of activities relating to HIV/AIDS. The interagency working group shall--

`(aa) meet regularly to review progress in host countries toward HIV/AIDS prevention, treatment, and care objectives;

`(bb) participate in the process of identifying countries in need of increased assistance based on the epidemiology of HIV/AIDS in those countries; and

`(cc) review policies that may be obstacles to reaching objectives set forth for HIV/AIDS prevention, treatment, and care.

`(V) Coordinating overall United States HIV/AIDS policy and programs with efforts led by host countries and with the assistance provided by other relevant bilateral and multilateral aid agencies and other donor institutions to achieve complementarity with other programs aimed at improving child and maternal health, and food security, promoting education, and strengthening health care systems.';

(B) by redesignating subclauses (VII) and (VIII) as subclauses (IX) and (X), respectively;

(C) by inserting after subclause (VI) the following:

`(VII) Holding annual consultations with host country nongovernmental organizations providing services to improve health, and advocating on behalf of the individuals with HIV/AIDS and those at particular risk of contracting HIV/AIDS.

`(VIII) Ensuring, through interagency and international coordination, that United States HIV/AIDS programs are coordinated with and complementary to the delivery of related global health, food security, and education services, including--

`(aa) maternal and child health care;

`(bb) services for other neglected and easily preventable and treatable infectious diseases, such as tuberculosis;

`(cc) treatment and care services for injection drug users; and

`(dd) programs and services to improve legal, social, and economic status of women and girls.';

(D) in subclause (IX) (as redesignated by subparagraph (B) of this paragraph)--

(i) by inserting `Vietnam, Antigua and Barbuda, the Bahamas, Barbados, Belize, Dominica, Grenada, Jamaica, Montserrat, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Saint Lucia, Suriname, Trinidad and Tobago, the Dominican Republic, Malawi, Swaziland, Lesotho' after `Zambia,';

(ii) by adding at the end before the period the following: `and other countries in which the United States is implementing HIV/AIDS programs'; and

(iii) by adding at the end the following: `In designating countries under this subclause, the President shall give priority to those countries in which there is a high prevalence of HIV/AIDS and countries with large populations that have a concentrated HIV/AIDS epidemic.';

(E) by redesignating subclause (X) (as redesignated by subparagraph (B) of this paragraph) as subclause (XII);

(F) by inserting after subclause (IX) (as redesignated by subparagraph (B) and amended by subparagraph (D) of this paragraph) the following:

`(X) Working, in partnership with host countries in which the HIV/AIDS epidemic is prevalent among injection drug users, to establish, as a national priority, national HIV/AIDS prevention programs, including education, and services demonstrated to be effective in reducing the transmission of HIV infection among injection drug users without increasing drug use.

`(XI) Working, in partnership with host countries in which the HIV/AIDS epidemic is prevalent among individuals involved in commercial sex acts, to establish, as a national priority, national prevention programs, including education, voluntary testing, and counseling, and referral systems that link HIV/AIDS programs with programs to eradicate trafficking in persons and create alternatives to prostitution.';

(G) in subclause (XII) (as redesignated by subparagraphs (B) and (E) of this paragraph), by striking `funds section' and inserting `funds appropriated pursuant to the authorization of appropriations under section 401 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 for HIV/AIDS assistance'; and

(H) by adding at the end the following:

`(XIII) Publicizing updated drug pricing data to inform pharmaceutical procurement partners' purchasing decisions.

`(XIV) Working in partnership with host countries in which the HIV/AIDS epidemic is prevalent among men who have sex with men, to establish, as a national priority, national HIV/AIDS prevention programs, including education and services demonstrated to be effective in reducing the transmission of HIV among men who have sex with men.'.

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

SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.

Section 201(a) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621(a)) is amended--

(1) in paragraph (2), by striking `infectious diseases' and inserting `easily preventable and treatable infectious diseases'; and

(2) in paragraph (4), by striking `infectious diseases' and inserting `easily preventable and treatable infectious diseases'.

SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA.

(a) Findings- Subsection (a) of section 202 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7622) is amended--

(1) by redesignating paragraphs (1) through (3) as paragraphs (7) through (9), respectively; and

(2) by inserting before paragraph (7) (as redesignated by paragraph (1) of this subsection) the following:

`(1) The Global Fund to Fight AIDS, Tuberculosis and Malaria is the multilateral component of this Act, extending United States efforts to a total of 136 countries around the world.

`(2) Created in 2002, the Global Fund has played a leading role in the fight against HIV/AIDS, tuberculosis, and malaria around the world and has grown into an organization that currently provides nearly a quarter of all international financing to combat HIV/AIDS and two-thirds of all international financing to combat tuberculosis and malaria.

`(3) By 2010, it is estimated that the demand for funding by the Global Fund will grow in size to between $6 and $8 billion annually, requiring significant contributions from donors around the world, including at least $2 billion annually from the United States.

`(4) The Global Fund is an innovative financing mechanism to combat HIV/AIDS, tuberculosis, and malaria, and has made progress in many areas.

`(5) The United States Government is the largest supporter of the Global Fund, both in terms of resources and technical support.

`(6) The United States made the initial contribution to the Global Fund and is fully committed to its success.'.

(b) United States Financial Participation-

(1) AUTHORIZATION OF APPROPRIATIONS- Subsection (d)(1) of such section is amended--

(A) by striking `$1,000,000,000' and inserting `$2,000,000,000';

(B) by striking `for the period of fiscal year 2004 beginning on January 1, 2004,' and inserting `for each of the fiscal years 2009 and 2010,'; and

(C) by striking `the fiscal years 2005-2008' and inserting `each of the fiscal years 2011 through 2013'.

(2) LIMITATION- Subsection (d)(4) of such section is amended--

(A) in subparagraph (A)--

(i) in clause (i), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013';

(ii) in clause (ii), by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'; and

(iii) in clause (vi)--

(I) by striking `for the purposes' and inserting `For the purposes';

(II) by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'; and

(III) by striking `fiscal year 2004' and inserting `fiscal year 2009';

(B) in subparagraph (B)(iv)--

(i) by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'; and

(ii) by adding at the end before the period the following: `, unless such amount is made available for more than one fiscal year, in which case such amount is authorized to be made available for such purposes after December 31 of the fiscal year following the fiscal year in which such funds first became available.'; and

(C) in subparagraph (C)(ii) by striking `Committee on International Relations' and inserting `Committee on Foreign Affairs'.

(3) STATEMENT OF POLICY- The following shall be the policy of the United States:

(A) Support for the Global Fund to Fight AIDS, Tuberculosis and Malaria should be based upon achievement of the following benchmarks related to transparency and accountability:

(i) As recommended by the Government Accountability Office, the Fund Secretariat has established standardized expectations for the performance of Local Fund Agents (LFAs), is undertaking a systematic assessment of the performance of LFAs, and is making available for public review, according to the Fund Board's policies and practices on disclosure of information, a regular collection and analysis of performance data of Fund grants, which shall cover both Principal Recipients and sub-recipients.

(ii) A well-staffed, independent Office of the Inspector General reports directly to the Board and is responsible for regular, publicly published audits of both financial and programmatic and reporting aspects of the Fund, its grantees, and LFAs, including both Principal Recipients and sub-recipients.

(iii) The Fund Secretariat has established and is reporting publicly on standard indicators for all program areas.

(iv) The Fund Secretariat has established a database that tracks all subrecipients and the amounts of funds disbursed to each, as well as the distribution of resources, by grant and Principal Recipient, for prevention, care, treatment, the purchases of drugs and commodities, and other purposes.

(v) The Fund Board has established a penalty to offset tariffs imposed by national governments on all goods and services provided by the Fund.

(vi) The Fund Board has successfully terminated its Administrative Services Agreement with the World Health Organization and completed the Fund Secretariat's transition to a fully independent status under the Headquarters Agreement the Fund has established with the Government of Switzerland.

(B) Support for the Global Fund to Fight AIDS, Tuberculosis and Malaria should be based upon achievement of the following benchmarks related to the founding principles of the Fund:

(i) The Fund must maintain its status as a financing institution.

(ii) The Fund must remain focused on programs directly related to HIV/AIDS, malaria, and tuberculosis.

(iii) The Fund must maintain its Comprehensive Funding Policy, which requires confirmed pledges to cover the full amount of new grants before the Board approves them.

(iv) The Fund must maintain and make progress on sustaining its multisectoral approach, through Country Coordinating Mechanisms (CCMs) and in the implementation of grants, as reflected in percent and resources allocated to different sectors, including governments, civil society, and faith- and community-based organizations.

(4) SENSE OF CONGRESS- Congress--

(A) notes that section 625 of Public Law 110-161 establishes a requirement to withhold 20 percent of funds appropriated for the Global Fund if the Global Fund fails to meet certain benchmarks; and

(B) will continue to review the implementation of the benchmarks to ensure accountability and transparency of the Global Fund.

SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.

(a) Vaccine Fund- Subsection (k) of section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) is amended by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'.

(b) International AIDS Vaccine Initiative- Subsection (l) of such section is amended by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'.

(c) Malaria Vaccine Development Programs- Subsection (m) of such section is amended by striking `fiscal years 2004 through 2008' and inserting `fiscal years 2009 through 2013'.

(d) Research and Development of a Tuberculosis Vaccine- Such section is further amended by adding at the end the following:

`(n) In addition to amounts otherwise available under this section, there are authorized to be appropriated to the President such sums as may be necessary for each of the fiscal years 2009 through 2013 to be available for United States contributions to research and development of a tuberculosis vaccine.'.

SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF MICROBICIDES TO PREVENT TRANSMISSION OF HIV AND OTHER DISEASES.

(a) Statement of Policy- Congress recognizes the need and urgency to expand the range of interventions for preventing the transmission of human immunodeficiency virus (HIV), including nonvaccine prevention methods that can be controlled by women.

(b) Program Authorized- 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, shall develop and implement a program to facilitate wide-scale availability of microbicides that prevent the transmission of HIV after such microbicides are proven safe and effective.

(c) Authorization of Appropriations- Of the amounts authorized to be appropriated under section 401 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there are authorized to be appropriated to the President such sums as may be necessary for each of the fiscal years 2009 through 2013 to carry out this section.

SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA BY STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF HOST COUNTRIES.

(a) In General- Title II of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621 et seq.) is amended by adding at the end the following:

`SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA BY STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF HOST COUNTRIES.

`(a) Findings- Congress makes the following findings:

`(1) One of the most significant barriers to achieving universal access to HIV/AIDS treatment and prevention in developing countries is the lack of health infrastructure, particularly in sub-Saharan Africa.

`(2) In addition to HIV/AIDS programs, other treatable and preventable infectious diseases could be treated concurrently and easily if health care delivery systems in developing countries were significantly improved.

`(3) More public investment in basic primary health care should be a priority in public spending in developing countries.

`(b) Statement of Policy- It shall be the policy of the United States Government--

`(1) to invest appropriate resources authorized under this Act and the amendments made by this Act to carry out activities to strengthen HIV/AIDS health policies and health systems and provide workforce training and capacity-building consistent with the goals and objectives of this Act and the amendments made by this Act; and

`(2) to support the development of a sound policy environment in host countries to increase the ability of such countries to maximize utilization of health care resources from donor countries, deliver services to the people of such host countries in an effective and efficient manner, and reduce barriers that prevent recipients of services from achieving maximum benefit from such services.

`(c) Plan Required- The Coordinator of United States Government Activities to Combat HIV/AIDS Globally, in collaboration with the Administrator of the United States Agency for International Development, shall develop and implement a plan to combat HIV/AIDS by strengthening health policies and health systems of host countries as part of the United States Agency for International Development'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 host countries, particularly in Africa, in collaboration with United States postsecondary educational institutions, 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.

`(d) Assistance To Improve Public Finance Management Systems-

`(1) IN GENERAL- The Secretary of the Treasury, acting through the head of the Office of Technical Assistance, is authorized to provide assistance for advisors and host country finance, health, and other relevant ministries to improve the effectiveness of public finance management systems in host countries to enable such countries to receive funding to carry out programs to combat HIV/AIDS, tuberculosis, and malaria and to manage such programs.

`(2) AUTHORIZATION OF APPROPRIATIONS- Of the amounts authorized to be appropriated under section 401 for HIV/AIDS assistance, there are authorized to be appropriated to the Secretary of the Treasury such sums as may be necessary for each of the fiscal years 2009 through 2013 to carry out this subsection.'.

(b) Clerical Amendment- The table of contents for the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by inserting after the item relating to section 203 the following:

`Sec. 204. Plan to combat HIV/AIDS by strengthening health policies and health systems of host countries.'.

TITLE III--BILATERAL EFFORTS

Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

(a) Amendments to the Foreign Assistance Act of 1961-

(1) FINDING- Subsection (a) of section 104A of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2) is amended by inserting `, South and Southeast Asia, Central and Eastern Europe' after `the Caribbean'.

(2) POLICY- Subsection (b) of such section is amended--

(A) in the first sentence--

(i) by striking `It is a major' and inserting the following:

`(1) GENERAL POLICY- It is a major';

(ii) by striking `control' and inserting `care'; and

(iii) by adding at the end before the period the following: `and to fulfill United States commitments to move toward the goal of universal access to prevention, treatment, and care of HIV/AIDS';

(B) by adding at the end the following: `The United States and other developed countries should provide assistance for the prevention, treatment, and care of HIV/AIDS to countries in sub-Saharan Africa, the Caribbean, South and Southeast Asia and Central and Eastern Europe, addressing both generalized epidemics and epidemics concentrated among populations at high risk of infection.'; and

(C) by further adding at the end the following:

`(2) SPECIFIC POLICY- It is therefore the policy of the United States, by 2013, to--

`(A) prevent 12,000,000 new HIV infections worldwide;

`(B) support treatment of at least 3,000,000 individuals with HIV/AIDS with the goal of treating 450,000 children;

`(C) provide care for 12,000,000 individuals affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children in communities affected by HIV/AIDS, including orphans with HIV/AIDS; and

`(D) train at least 140,000 new health care professionals and workers for HIV/AIDS prevention, treatment and care.'.

(3) AUTHORIZATION- Subsection (c) of such section is amended--

(A) in paragraph (1)--

(i) by inserting `, South and Southeast Asia, Central and Eastern Europe' after `the Caribbean'; and

(ii) by adding at the end before the period the following: `, and particularly with respect to refugee populations in such countries and areas';

(B) in paragraph (2)--

(i) by inserting `, South and Southeast Asia, Central and Eastern Europe' after `the Caribbean'; and

(ii) by adding at the end before the period the following: `, and particularly with respect to refugee populations in such countries and areas';

(C) by redesignating paragraph (3) as paragraph (4);

(D) by inserting after paragraph (2) the following:

`(3) ROLE OF PUBLIC HEALTH CARE DELIVERY SYSTEMS- It is the sense of Congress that--

`(A) the President should provide an appropriate level of assistance under paragraph (1) to help strengthen public health care delivery systems financed by host countries; and

`(B) the President, acting through the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, should support the development of a policy framework in such host countries for the long-term sustainability of HIV/AIDS prevention, treatment, and care programs, and for strengthening health care delivery systems and increasing health workforces through recruitment, training, and policies that allows the devolution of clinical responsibilities to increase the work force able to deliver prevention, treatment, and care services, as necessary, with clearly identified objectives and reporting strategies for such services.';

(E) in paragraph (4) (as redesignated by subparagraph (C) of this paragraph), by striking `foreign countries' and inserting `host countries and donor countries'; and

(F) by adding at the end the following:

`(5) SENSE OF CONGRESS-

`(A) IN GENERAL- It is the sense of Congress that the Coordinator of United States Government Activities to Combat HIV/AIDS Globally and the heads of relevant executive branch agencies (as such term is defined in section 3 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) should operate in a manner consistent with the `Three Ones' goals of UNAIDS.

`(B) `THREE ONES' GOALS OF UNAIDS DEFINED- In this paragraph, the term `Three Ones' goals of UNAIDS' means--

`(i) the goal of one agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners in host countries;

`(ii) the goal of one national HIV/AIDS coordinating authority, with a broad-based multisectoral mandate; and

`(iii) the goal of one agreed country-level data-collection, monitoring, and evaluation system.'.

(4) ACTIVITIES SUPPORTED-

(A) PREVENTION- Subsection (d)(1) of such section is amended--

(i) in subparagraph (A)--

(I) by inserting `efforts by faith-based and other nongovernmental organizations and' after `infection, including';

(II) by inserting `, including access to such programs and efforts in family planning programs supported by the United States Government,' after `health programs'; and

(III) by inserting `male and female' before `condoms';

(ii) in subparagraph (B)--

(I) by inserting `relevant and' after `culturally';

(II) by inserting `and programs' after `those organizations'; and

(III) by inserting `, level of scientific and fact-based knowledge' after `experience';

(iii) in subparagraph (D), by inserting `and nonjudgmental approaches' after `protections';

(iv) by amending subparagraph (E) to read as follows:

`(E) assistance to achieve the target of reaching 80 percent of pregnant women for prevention and treatment of mother-to-child transmission of HIV in countries in which the United States is implementing HIV/AIDS programs by 2013, as described in section 312(b)(1) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, and to promote infant feeding options that meet the criteria described in the World Health Organization's Global Strategy for Infant and Young Child Feeding;';

(v) in subparagraph (G)--

(I) by adding at the end before the semicolon the following: `, including education and services demonstrated to be effective in reducing the transmission of HIV infection without increasing illicit drug use'; and

(II) by striking `and' at the end;

(vi) in subparagraph (H), by striking the period at the end and inserting `; and'; and

(vii) by adding at the end the following:

`(I)(i) assistance for counseling, testing, treatment, care, and support programs for prevention of re-infection of individuals with HIV/AIDS;

`(ii) counseling to prevent sexual transmission of HIV, including skill development for practicing abstinence, reducing the number of sexual partners, and providing information on correct and consistent use of male and female condoms;

`(iii) assistance to provide male and female condoms;

`(iv) diagnosis and treatment of other sexually-transmitted infections;

`(v) strategies to address the stigma and discrimination that impede HIV/AIDS prevention efforts; and

`(vi) assistance to facilitate widespread access to microbicides for HIV prevention, as safe and effective products become available, including financial and technical support for culturally appropriate introductory programs, procurement, distribution, logistics management, program delivery, acceptability studies, provider training, demand generation, and post-introduction monitoring; and

`(J) assistance for HIV/AIDS education targeted to reach and prevent the spread of HIV among men who have sex with men.'.

(B) TREATMENT- Subsection (d)(2) of such section is amended--

(i) in subparagraph (B), by striking `; and' at the end and inserting a semicolon;

(ii) in subparagraph (C), by striking the period at the end and inserting a semicolon; and

(iii) by adding at the end the following:

`(D) assistance specifically to address barriers that might limit the start of and adherence to treatment services, especially in rural areas, through such measures as mobile and decentralized distribution of treatment services, and where feasible and necessary, direct linkages with nutrition, safe drinking water, and income security programs, referrals to services for victims of violence, support groups for individuals with HIV/AIDS, and efforts to combat stigma and discrimination against all such individuals;

`(E) assistance to support comprehensive HIV/AIDS treatment (including free prophylaxis and treatment for common HIV/AIDS-related opportunistic infections) for at least one-third of individuals with HIV/AIDS in the poorest countries worldwide who are in clinical need of antiretroviral treatment; and

`(F) assistance to improve access to psychosocial support systems and other necessary services for youth who are infected with HIV to ensure the start of and adherence to treatment services.'.

(C) MONITORING- Subsection (d)(4) of such section is amended--

(i) by striking `The monitoring' and inserting the following:

`(A) IN GENERAL- The monitoring';

(ii) by inserting `and paragraph (8)' after `paragraphs (1) through (3)';

(iii) by redesignating subparagraphs (A) through (D) as clauses (i) through (iv), respectively;

(iv) in clause (iii) (as redesignated by clause (iii) of this subparagraph), by striking `and' at the end;

(v) in clause (iv) (as redesignated by clause (iii) of this subparagraph), by striking the period at the end and inserting `; and';

(vi) by adding at the end the following:

`(v) carrying out and expanding program monitoring, impact evaluation research, and operations research (including research and evaluations of gender