The following are excerpts, highlighted in red, from the final legislation and/or conference report which contain references to and studies for The National Academies. (Pound signs [##] between passages denote the deletion of unrelated text.)
HR5501 Berman (D-Calif.) 7/24/08
Enrolled (finally passed both houses)
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.
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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) On May 27, 2003, the President signed this Act into law, launching the largest international public health program of its kind ever created.
“(30) Between 2003 and 2008, the United States, through the President’s Emergency Plan for AIDS Relief (PEPFAR) and in conjunction with other bilateral programs and the multilateral Global Fund has helped to—
“(A) provide antiretroviral therapy for over 1,900,000 people;
“(B) ensure that over 150,000 infants, most of whom would have likely been infected with HIV during pregnancy or childbirth, were not infected; and
“(C) provide palliative care and HIV prevention assistance to millions of other people.
“(31) While United States leadership in the battles against HIV/AIDS, tuberculosis, and malaria has had an enormous impact, these diseases continue to take a terrible toll on the human race.
“(32) According to the 2007 AIDS Epidemic Update of the Joint United Nations Programme on HIV/AIDS (UNAIDS)—
“(A) an estimated 2,100,000 people died of AIDS-related causes in 2007; and
“(B) an estimated 2,500,000 people were newly infected with HIV during that year.
“(33) According to the World Health Organization, malaria kills more than 1,000,000 people per year, 70 percent of whom are children under 5 years of age.
“(34) According to the World Health Organization, 1/3 of the world’s population is infected with the tuberculosis bacterium, and tuberculosis is 1 of the greatest infectious causes of death of adults worldwide, killing 1,600,000 people per year.
“(35) Efforts to promote abstinence, fidelity, the correct and consistent use of condoms, the delay of sexual debut, and the reduction of concurrent sexual partners represent important elements of strategies to prevent the transmission of HIV/AIDS.
“(36) According to UNAIDS—
“(A) women and girls make up nearly 60 percent of persons in sub-Saharan Africa who are HIV positive;
“(B) women and girls are more biologically, economically, and socially vulnerable to HIV infection; and
“(C) gender issues are critical components in the effort to prevent HIV/AIDS and to care for those affected by the disease.
“(37) Children who have lost a parent to HIV/AIDS, who are otherwise directly affected by the disease, or who live in areas of high HIV prevalence may be vulnerable to the disease or its socioeconomic effects.
“(38) Lack of health capacity, including insufficient personnel and inadequate infrastructure, in sub-Saharan Africa and other regions of the world is a critical barrier that limits the effectiveness of efforts to combat HIV/AIDS, tuberculosis, and malaria, and to achieve other global health goals.
“(39) On March 30, 2007, the Institute of Medicine of the National Academies released a report entitled ‘PEPFAR Implementation: Progress and Promise’, which found that budget allocations setting percentage levels for spending on prevention, care, and treatment and for certain subsets of activities within the prevention category—
“(A) have ‘adversely affected implementation of the U.S. Global AIDS Initiative’;
“(B) have inhibited comprehensive, integrated, evidence based approaches;
“(C) ‘have been counterproductive’;
“(D) ‘may have been helpful initially in ensuring a balance of attention to activities within the 4 categories of prevention, treatment, care, and orphans and vulnerable children’;
“(E) ‘have also limited PEPFAR’s ability to tailor its activities in each country to the local epidemic and to coordinate with the level of activities in the countries’ national plans’; and
“(F) should be removed by Congress and replaced with more appropriate mechanisms that—
“(i) ‘ensure accountability for results from Country Teams to the U.S. Global AIDS Coordinator and to Congress’; and
“(ii) ‘ensure that spending is directly linked to and commensurate with necessary efforts to achieve both country and overall performance targets for prevention, treatment, care, and orphans and vulnerable children’.
“(40) The United States Government has endorsed the principles of harmonization in coordinating efforts to combat HIV/AIDS commonly referred to as the ‘Three Ones’, which includes—
“(A) 1 agreed HIV/AIDS action framework that provides the basis for coordination of the work of all partners;
“(B) 1 national HIV/AIDS coordinating authority, with a broadbased multisectoral mandate; and
“(C) 1 agreed HIV/AIDS country-level monitoring and evaluating system.
“(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, of April 26-27, 2001 (referred to in this Act as the ‘Abuja Declaration’), the Heads of State and Government of the Organization of African Unity (OAU)—
“(A) declared that they would ‘place the fight against HIV/AIDS at the forefront and as the highest priority issue in our respective national development plans’;
“(B) committed ‘TO TAKE PERSONAL RESPONSIBILITY AND PROVIDE LEADERSHIP for the activities of the National AIDS Commissions/Councils’;
“(C) resolved ‘to lead from the front the battle against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by personally ensuring that such bodies were properly convened in mobilizing our societies as a whole and providing focus for unified national policymaking and programme implementation, ensuring coordination of all sectors at all levels with a gender perspective and respect for human rights, particularly to ensure equal rights for people living with HIV/AIDS’; and
“(D) pledged ‘to set a target of allocating at least 15% of our annual budget to the improvement of the health sector’.”.
SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 5-YEAR, GLOBAL STRATEGY.
(a) Strategy.—Section 101(a) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7611(a)) is amended to read as follows:
(c) Study.—Section 101(c) of such Act (22 U.S.C. 7611(c)) is amended to read as follows:
“(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 the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, 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.
“(A) IN GENERAL.—Not later than 4 years after the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, 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 Act on behalf of orphans and vulnerable children;
“(vii) an evaluation of the impact of programs and activities authorized in this Act 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.”.
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Amendments to the Foreign Assistance Act of 1961.—
(d) Compacts and Framework Agreements.—Section 104A of such Act is amended—
(1) by redesignating subsections (e) through (g) as subsections (f) through (h); and
(2) by inserting after subsection (d) the following:
“(e) Compacts and Framework Agreements.—
“(1) FINDINGS.—Congress makes the following findings:
“(A) The congressionally mandated Institute of Medicine report entitled ‘PEPFAR Implementation: Progress and Promise’ states: ‘The next strategy [of the U.S. Global AIDS Initiative] should squarely address the needs and challenges involved in supporting sustainable country HIV/AIDS programs, thereby transitioning from a focus on emergency relief.’.
“(B) One mechanism to promote the transition from an emergency to a public health and development approach to HIV/AIDS is through compacts or framework agreements between the United States Government and each participating nation.
“(2) ELEMENTS.—Compacts on HIV/AIDS authorized under subsection (d)(8) shall include the following elements:
“(A) Compacts whose primary purpose is to provide direct services to combat HIV/AIDS are to be made between—
“(i) the United States Government; and
“(ii)(I) national or regional entities representing low-income countries served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; or
“(II) countries or regions—
“(aa) experiencing significantly high HIV prevalence or risk of significantly increasing incidence within the general population;
“(bb) served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; and
“(cc) that have inadequate financial means within such country or region.
“(B) Compacts whose primary purpose is to provide limited technical assistance to a country or region connected to services provided within the country or region—
“(i) may be made with other countries or regional entities served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform;
“(ii) shall require significant investments in HIV prevention, care, and treatment services by the host country;
“(iii) shall be time-limited in terms of United States contributions; and
“(iv) shall be made only upon prior notification to Congress—
“(I) justifying the need for such compacts;
“(II) describing the expected investment by the country or regional entity; and
“(III) describing the scope, nature, expected total United States investment, and time frame of the limited technical assistance under the compact and its intended impact.
“(C) Compacts shall include provisions to—
“(i) promote local and national efforts to reduce stigma associated with HIV/AIDS; and
“(ii) work with and promote the role of civil society in combating HIV/AIDS.
“(D) Compacts shall take into account the overall national health and development and national HIV/AIDS and public health strategies of each country.
“(E) Compacts shall contain—
“(i) consideration of the specific objectives that the country and the United States expect to achieve during the term of a compact;
“(ii) consideration of the respective responsibilities of the country and the United States in the achievement of such objectives;
“(iii) consideration of regular benchmarks to measure progress toward achieving such objectives;
“(iv) an identification of the intended beneficiaries, disaggregated by gender and age, and including information on orphans and vulnerable children, to the maximum extent practicable;
“(v) consideration of the methods by which the compact is intended to—
“(I) address the factors that put women and girls at greater risk of HIV/AIDS; and
“(II) strengthen elements such as the economic, educational, and social status of women, girls, orphans, and vulnerable children and the inheritance rights and safety of such individuals;
“(vi) consideration of the methods by which the compact will—
“(I) strengthen the health care capacity, including factors such as the training, retention, deployment, recruitment, and utilization of health care workers;
“(II) improve supply chain management; and
“(III) improve the health systems and infrastructure of the partner country, including the ability of compact participants to maintain and operate equipment transferred or purchased as part of the compact;
“(vii) consideration of proposed mechanisms to provide oversight;
“(viii) consideration of the role of civil society in the development of a compact and the achievement of its objectives;
“(ix) a description of the current and potential participation of other donors in the achievement of such objectives, as appropriate; and
“(x) consideration of a plan to ensure appropriate fiscal accountability for the use of assistance.
“(F) For regional compacts, priority shall be given to countries that are included in regional funds and programs in existence as of the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
“(G) Amounts made available for compacts described in subparagraphs (A) and (B) shall be subject to the inclusion of—
“(i) cost sharing assurances that meet the requirements under section 110; and
“(ii) transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, and budget support by respective foreign governments.
“(3) LOCAL INPUT.—In entering into a compact on HIV/AIDS authorized under subsection (d)(8), the Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall seek to ensure that the government of a country—
“(A) takes into account the local perspectives of the rural and urban poor, including women, in each country; and
“(B) consults with private and voluntary organizations, including faith-based organizations, the business community, and other donors in the country.
“(4) CONGRESSIONAL AND PUBLIC NOTIFICATION AFTER ENTERING INTO A COMPACT.—Not later than 10 days after entering into a compact authorized under subsection (d)(8), the Global AIDS Coordinator shall—
“(A) submit a report containing a detailed summary of the compact and a copy of the text of the compact to—
“(i) the Committee on Foreign Relations of the Senate;
“(ii) the Committee on Appropriations of the Senate;
“(iii) the Committee on Foreign Affairs of the House of Representatives; and
“(iv) the Committee on Appropriations of the House of Representatives; and
“(B) publish such information in the Federal Register and on the Internet website of the Office of the Global AIDS Coordinator.”.
(g) Relationship To Assistance Programs To Enhance Nutrition.—Section 301(c) of such Act is amended to read as follows:
“(c) Food and Nutritional Support.—
“(1) IN GENERAL.—As indicated in the report produced by the Institute of Medicine, entitled ‘PEPFAR Implementation: Progress and Promise’, inadequate caloric intake has been clearly identified as a principal reason for failure of clinical response to antiretroviral therapy. In recognition of the impact of malnutrition as a clinical health issue for many persons living with HIV/AIDS that is often associated with health and economic impacts on these individuals and their families, the Global AIDS Coordinator and the Administrator of the United States Agency for International Development shall—
“(A) follow World Health Organization guidelines for HIV/AIDS food and nutrition services;
“(B) integrate nutrition programs with HIV/AIDS activities through effective linkages among the health, agricultural, and livelihood sectors and establish additional services in circumstances in which referrals are inadequate or impossible;
“(C) provide, as a component of care and treatment programs for persons with HIV/AIDS, food and nutritional support to individuals infected with, and affected by, HIV/AIDS who meet established criteria for nutritional support (including clinically malnourished children and adults, and pregnant and lactating women in programs in need of supplemental support), including—
“(i) anthropometric and dietary assessment;
“(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 section 401, there are authorized to be appropriated to the President such sums as may be necessary for each of the fiscal years 2009 through 2013 to carry out this subsection.”.