LEGISLATIVE BULLETIN | July 10, 2008

S. 2731, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008

This Legislative Bulletin draws on information provided by the Majority staff of the Senate Foreign Relations Committee. 

Summary

S. 2731, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008,would authorize $50 billion over Fiscal Years 2009 through 2013 for United States bilateral and multilateral programs to combat human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and malaria. The bill would require the President to establish a new five-year strategy to fight HIV/AIDS, TB, and malaria, as part of the overall United States health and development agenda; call for increased resources for bilateral and multilateral efforts to combat these diseases; seek to intensify prevention, treatment, and care efforts and enhance program effectiveness, including addressing the particular vulnerabilities of girls and women; encourage public-private partnerships; reinforce vaccine development and other research, including operations research; and help partner countries to strengthen health systems and improve capacity. 

 

Major Provisions

Title I: Policy Planning and Coordination

Development of a comprehensive, 5-year, global strategy. The bill would amend section 101 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (also known as the 2003 Leadership Act) by providing additional guidance to the President on the development of the second 5-year integrated plan to improve efforts to combat HIV/AIDS globally and requiring a subsequent report to Congress.

 

Specifically, the bill would: 

•Instruct the President to situate U.S. efforts to combat HIV/AIDS, tuberculosis, and malaria within the broader global health and development agenda;

•Call on the President to provide a plan to be carried out over the next five years to prevent 12 million new HIV infections worldwide, support care for 12 million adults and children with HIV/AIDS (including 5 million orphans and other children affected by the disease), and support the treatment of persons with HIV/AIDS through bilateral efforts as well as through multilateral programs;

•Establish targets to promote universal access (defined as 80 percent) to services to prevent mother-to-child transmission, to treat children in proportion to their numbers within a country's population of persons with HIV/AIDS, and to strengthen health workforces. This section also prioritizes the importance of HIV prevention; requires a timetable for achieving treatment targets; and calls on the President to strengthen health capacity in, and coordination with, the national HIV/AIDS strategies of partner countries and to promote coordination in U.S. responses to HIV/AIDS, tuberculosis and malaria; and

•Call for a plan for regional priorities for resource distribution and a structure for new compacts and agreements, underscoring the importance of addressing the needs of women and girls and also requiring estimates for long-term needs and progress toward sustainability and greater country ownership of their HIV/AIDS programs.

 

Oversight, evaluation, and reporting provisions. S. 2731would require the Global AIDS Coordinator to commission a study by the Institute of Medicine to assess the progress and outcomes of U.S. global HIV/AIDS program. The bill also provides for a GAO report on monitoring evaluation, coordination, and impact of HIV/AIDS funding and programs on U.S. global health programs as a whole as well as an annual report of "Best Practices" based on operations research. Further, it would require joint, coordinated plans by the Inspectors General (IG) of the State Department, the Department of Health and Human Services (HHS), and the U.S. Agency for International Development (USAID) and authorizes the transfer of up to $15 million to these IGs to support financial audits and performance reviews. 

Interagency working group.The bill would amend current law to strengthen and expand the responsibilities of the Global AIDS Coordinator to provide for an increased role in consulting with foreign governments, nongovernmental organizations, and other U.S. government agencies, including establishing and heading a working group consisting of representatives from USAID and HHS.

 

 

Title II: Support for Multilateral Funds, Programs, and Public-Private Partnerships

Voluntary contributions to international vaccine funds.The bill reauthorizes existing programs under the Foreign Assistance Act of 1961, including the vaccine fund, the International AIDS Vaccine Initiative, and the malaria vaccine development program for Fiscal Years 2009 to 2013 and also provides new authorization for a U.S. contribution to tuberculosis vaccine development programs. 

Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria. S. 2731amends the 2003 Leadership Actregarding U.S. contributions to the Global Fund. Specifically, the bill would: 

•Increase the annual authorization for U.S. contributions to the Fund from $1 billion to up to $2 billion for Fiscal Year 2009 and such sums as necessary for Fiscal Years 2010 through 2013;

•Include a Presidential waiver to allow the Global Fund to work in Southern Sudan without incurring a deduction in the U.S. contribution;

•Establish a policy that instructs the Global AIDS Coordinator, in conjunction with the Global Fund, to work to prevent the imposition of duties, tariffs and taxes on goods and services provided by the Global Fund; and

•Provide new benchmarks for improving the accountability and transparency of the Fund's activities, including a provision that would withhold 20 percent of appropriated funds until the Secretary of State certifies the achievement of certain benchmarks.

 

Microbicide research and development.S. 2731 includes several provisions for expanding the range of interventions for preventing the transmission of HIV, including non-vaccine prevention methods that can be controlled by women. 

Specifically, the bill would:

•Require the Director of the National Institutes of Health (NIH) Office of AIDS Research to develop and implement federal strategic plans for microbicide research (as required by the Public Health Service Act) and to review and update plans as appropriate;

•Instruct the Director of the National Institute of Allergy and Infectious Diseases, to carry out research on, and development of, safe and effective methods for use by women to prevent the transmission of HIV, which may include microbicides;

•Encourage the Director of the Centers for Disease Control and Prevention (CDC) to fully implement the Centers' microbicide agenda to support research and development of microbicides to prevent the transmission of HIV;

•Authorize the Administrator of the USAID, in coordination with the Global AIDS Coordinator, to facilitate availability and accessibility of microbicides, provided that they have been authorized for use by the Food and Drug Administration (FDA) or another stringent regulatory agency or quality assurance mechanism acceptable to the Secretary of HHS; and

•Authorize such sums as may be necessary for Fiscal Years 2009 through 2013 to carry out the provisions in this section.

 

Additional requirements and provisions. This title also would: 

•Include new provisions for strengthening health policies and health systems of host countries, including the authorization of the appropriation of funds to the Department of Treasury to provide technical assistance to host countries to improve the public finance management systems of such countries to enable them to receive HIV/AIDS assistance, collect revenue and manage their own programs;

•Provide additional authorities for the Secretary of Health and Human Services to facilitate CDC's international activities as part of the President's Emergency Plan for AIDS Relief (PEPFAR);

•Authorize the Administrator of USAID, utilizing public-private partnerships and in coordination with other international development agencies, to gather and analyze data and review protocols that could lead to the development of vaccines for HIV/AIDS, tuberculosis and malaria; and

•Require a report on the status of the United States' participation in programs for the advanced market commitments for the development of such vaccines. 

 

Title III: Bilateral Efforts 

The bill would amend current law (the Foreign Assistance Act of 1961 and the 2003 Leadership Act) on bilateral U.S. HIV/AIDS assistance. Specifically, it states that it is a policy objective of the United States for Fiscal Years 2009 to 2013 to assist countries in: 

•Preventing 12 million new HIV infections;

•Supporting treatment of people with HIV/AIDS through bilateral and multilateral efforts above an initial target of two million persons (following a formula for increasing this target in Sec. 403);

•Supporting care for 12 million people infected with or affected by HIV/AIDS (including five million orphans and vulnerable children);

•Providing 80 percent access (the level often defined as universal access) to counseling and services for prevention of mother to child transmission;

•Providing care and treatment services to children with HIV/AIDS in proportion to their percentage within the population of persons who are infected; and

•Training 140,000 new healthcare paraprofessionals and professionals, with an emphasis on doctors and nurses where needed.

 

Assistance to combat tuberculosis.S. 2731 would amend the Foreign Assistance Act of 1961 to support the achievement of the goals established in the Global Plan to Stop TB. It includes a requirement to provide assistance to combat tuberculosis and a list of activities to be carried out, including diagnostic testing and counseling, treatment, and implementation of protocols to address drug resistance and also establishes targets and includes increased reporting requirements for TB activities. Further, the bill would authorize a total of $4 billion for Fiscal Years 2009 to 2013 for assistance to combat tuberculosis. 

Assistance to combat malaria.The bill would amend the Foreign Assistance Act of 1961 to ensure that treatment is part of U.S. efforts to combat malaria. It would amend the 2003 Leadership Act to authorize a total of $5 billion for Fiscal Years 2009 to 2013 for assistance to combat malaria. 

Malaria Response Coordinator. S. 2731would amend the 2003 Leadership Act by adding a requirement for a comprehensive strategy to combat malaria and to establish within USAID a Malaria Coordinator. It also would authorize contributions to the Roll Back Malaria Partnership and the World Health Organization; funding for research by relevant U.S. agencies to address prevention, treatment and care of malaria; and would require an annual report on the prevention, treatment, control and elimination of malaria. 

Amendment to the Immigration and Nationality Act.The bill would amend the Immigration and Nationality Act (INA) by striking the statutory ban on persons with HIV entering the country, which was enacted into law in 1993. This provision would not affect the regulatory power under the INA for the Secretary to bar admission of individuals who have a "communicable disease of public health significance." Nor would it affect the current regulation, pursuant to the INA, that includes HIV as one such disease. Potential costs, estimated by CBO at $83 million in direct spending over the next 10 years, are offset by increased visa fees under Section 501.

 

Additional provisions included in this title would: 

•Establish targets for reaching 80 percent of the target population for prevention of mother-to-child transmission (PMTCT) of HIV and to seek to ensure that the proportion of children receiving care and treatment for HIV/AIDS is proportionate to their numbers within the population of HIV infected persons;

•Call for the integration of care and treatment with PMTCT programs; expanding programs for orphans and for children who are affected by or vulnerable to HIV/AIDS, for increasing access of women in PMTCT programs to maternal and child health services, and for a timeline for expanding access to PMTCT regimes;

•Require annual reports on prevention of mother-to-child transmission of the HIV infection; and

•Establish a prevention of mother-to-child transmission expert panel to produce a report on findings and recommendations.

 

Title IV: Funding Allocations 

Authorization of appropriations. The bill would increase the authorization under the 2003 Leadership Act to $50 billion for Fiscal Years 2009 to 2013, to allow for gradual expansion of the program (the House-passed bill would provide an authorization of $10 billion per fiscal year). 

Allocation of funds. This bill includes several provisions pertaining to the allocation of funding, which would: 

•Require that the Coordinator provide balanced funding for prevention activities for sexual transmission of HIV/AIDS for each host country, based on objective epidemiological evidence as to the source of infection and in consultation with the government of each host country involved in HIV/AIDS prevention activities; 

•Instruct the Coordinator to establish an HIV sexual transmission prevention strategy governing the expenditure of funds authorized by the Act used to prevent the sexual transmission of HIV in any host country with a generalized epidemic. In each such host country, if this strategy provides less than 50 percent of such funds for activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction, the Coordinator shall, within 30 days of the issuance of this strategy, report to the appropriate congressional committees on the justification for this decision. The subsection excludes new prevention technologies or modalities such as medical male circumcision as well as PMTCT and counseling and testing activities from calculations to determine compliance with the balanced funding reporting requirement. 

•Maintain the 10 percent earmark for orphans and vulnerable children, and modify the focus of this effort to include children who are vulnerable to as well as affected by HIV/AIDS to allow greater flexibility in providing services to at risk children, especially in communities with high prevalence rates. 

•Require that for each of the fiscal years 2009 through 2013, more than half of the amounts appropriated for bilateral global HIV/AIDS assistance be expended for: Antiretroviral treatment (ARV) treatment, clinical monitoring, care for associated opportunistic infections, nutrition and food support, and other essential HIV/AIDS-related medical care for people living with HIV/AIDS. 

 

TITLE V - Miscellaneous

Machine readable visa fees. The bill would increaseby $1 the fee charged to cover costs of the Machine Readable Visa fee paid by persons applying for Non-Immigrant Visas to the United States, effective no later than October 1, 2008. This fee shall be raised to $2 no later than October 1, 2013. Under this section, the money would be directed to the Treasury and would more than offset potential costs that Congressional Budget Office (CBO) concluded could be incurred as a subsequent result of the amendment to the Immigration and Nationality Act.

 

 

Legislative History

On March 13, 2008, the Senate Foreign Relations Committee favorably reported S. 2731, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, with amendments by a vote of 18-3. On April 15, 2008, Senator Biden reported the bill with an amendment in the nature of a substitute. 

On April 2, 2008, the House of Representatives passed H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, which differs somewhat from the bill now being considered in the Senate,by a vote of 308 to 116. 

 

Statement of Administration Policy

On April 1, 2008, the White House issued a Statement of Administration Policy (SAP) in support of passage by the House of Representatives of H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, as reported by the House Committee on Foreign Relations. The SAP can be viewed at the Office of Management and Budget's website, (http://www.whitehouse.gov/omb/legislative/sap/110-2/saphr5501-h.pdf).At the time of publication, no SAP has been issued for the Senate version of the bill, S. 2731.

 

Expected Amendments

The DPC will circulate information on amendments as it becomes available.

DPC