---
kind: "range"
citation: "22 U.S.C. §§ 2151b–2151b–4"
title: "22"
from: "2151b"
to: "2151b–4"
count: 5
release: "119-102"
url: "https://uscodex.org/usc/22/2151b..2151b-4"
---

# §2151b. Population planning and health programs

- (a) **Congressional declaration of policy—** The Congress recognizes that poor health conditions and uncontrolled population growth can vitiate otherwise successful development efforts.

  Large [families](/usc/22/4304a.md?p=c-2) in developing countries are the result of complex social and economic factors which change relatively slowly among the poor majority least affected by economic progress, as well as the result of a lack of effective birth control. Therefore, effective [family](/usc/22/4304a.md?p=c-2) planning depends upon economic and social change as well as the delivery of services and is often a matter of political and religious sensitivity. While every country has the right to determine its own policies with respect to population growth, voluntary population planning [programs](/usc/22/3383.md?p=6) can make a substantial contribution to economic development, higher living standards, and improved health and nutrition.

  Good health conditions are a principal element in improved quality of life and contribute to the individual’s capacity to participate in the development process, while poor health and debilitating disease can limit productivity.

- (b) **Assistance for voluntary population planning—** In order to increase the opportunities and motivation for [family](/usc/22/4304a.md?p=c-2) planning and to reduce the rate of population growth, the President is authorized to furnish assistance, on such terms and conditions as he may determine, for voluntary population planning. In addition to the provision of [family](/usc/22/4304a.md?p=c-2) planning information and services, including also information and services which relate to and support natural [family](/usc/22/4304a.md?p=c-2) planning methods, and the conduct of directly relevant demographic research, population planning [programs](/usc/22/3383.md?p=6) shall emphasize motivation for small [families](/usc/22/4304a.md?p=c-2).
- (c) **Assistance for health programs; special health needs of children and mothers; Child Survival Fund; promotion of immunization and oral rehydration; control of AIDS and tuberculosis—**
  - (1) In order to contribute to improvements in the health of the greatest number of poor people in developing countries, the President is authorized to furnish assistance, on such terms and conditions as he may determine, for health [programs](/usc/22/3383.md?p=6). Assistance under this subsection shall be used primarily for basic integrated health services, safe water and sanitation, disease prevention and control, and related health planning and research. This assistance shall emphasize self-sustaining community-based health [programs](/usc/22/3383.md?p=6) by means such as [training](/usc/22/8921.md?p=3) of health auxiliary and other appropriate personnel, support for the establishment and evaluation of proj­ects that can be replicated on a broader scale, measures to improve management of health [programs](/usc/22/3383.md?p=6), and other services and supplies to support health and disease prevention [programs](/usc/22/3383.md?p=6).
  - (2)
    - (A) In carrying out the purposes of this subsection, the President shall promote, encourage, and undertake activities designed to deal directly with the special health needs of children and mothers. Such activities should utilize simple, available technologies which can significantly reduce childhood mortality, such as improved and expanded immunization [programs](/usc/22/3383.md?p=6), oral rehydration to combat diarrhoeal diseases, and education [programs](/usc/22/3383.md?p=6) aimed at improving nutrition and sanitation and at promoting child spacing. In carrying out this paragraph, guidance shall be sought from knowledgeable health professionals from outside the agency primarily responsible for administering subchapter I of this chapter. In addition to government-to-government [programs](/usc/22/3383.md?p=6), activities pursuant to this paragraph should include support for appropriate activities of the types described in this paragraph which are carried out by [international organizations](/usc/22/4316.md?p=e-2) (which may include [international organizations](/usc/22/4316.md?p=e-2) receiving [funds](/usc/22/2431a.md?p=9) under part III of this subchapter) and by private and voluntary organizations, and should include encouragement to other donors to support such types of activities.
    - (B) In addition to amounts otherwise available for such purpose, there are authorized to be appropriated to the President $25,000,000 for fiscal year 1986 and $75,000,000 for fiscal year 1987 for use in carrying out this paragraph. Amounts appropriated under this subparagraph are authorized to remain available until expended.
    - (C) Appropriations pursuant to [subparagraph (B)](#c-2-B) may be referred to as the “Child Survival [Fund](/usc/22/2431a.md?p=9)”.
  - (3) The Congress recognizes that the promotion of primary health care is a major objective of the [foreign assistance](/usc/22/2394.md?p=b-1) [program](/usc/22/3383.md?p=6). The Congress further recognizes that simple, relatively low cost means already exist to reduce incidence of communicable diseases among children, mothers, and infants. The promotion of vaccines for immunization, and salts for oral rehydration, therefore, is an essential feature of the health assistance [program](/usc/22/3383.md?p=6). To this end, the Congress expects the agency primarily responsible for administering subchapter I of this chapter to set as a goal the protection of not less than 80 percent of all children, in those countries in which such agency has established development [programs](/usc/22/3383.md?p=6), from immunizable diseases by January 1, 1991. Of the aggregate amounts made available for fiscal year 1987 to carry out paragraph (2) of this subsection (relating to the Child Survival [Fund](/usc/22/2431a.md?p=9)) and to carry out [subsection (c)](#c) (relating to development assistance for health), $50,000,000 shall be used to carry out this paragraph.
  - (4) **Relationship to other laws.—** Assistance made available under this subsection and sections [2151b–2](/usc/22/2151b–2.md), [2151b–3](/usc/22/2151b–3.md), and [2151b–4](/usc/22/2151b–4.md) of this title, and assistance made available under part IV of subchapter II of this chapter to carry out the purposes of this subsection and the provisions cited in this paragraph, may be made available notwithstanding any other provision of law that restricts assistance to [foreign countries](/usc/22/2321c.md?p=2), except for the provisions of this subsection, the provisions of law cited in this paragraph, [subsection (f)](#f), [section 2394–1 of this title](/usc/22/2394–1.md), and provisions of law that limit assistance to organizations that support or participate in a [program](/usc/22/3383.md?p=6) of coercive abortion or involuntary sterilization included under the Child Survival and Health [Programs](/usc/22/3383.md?p=6) [Fund](/usc/22/2431a.md?p=9) heading in the Consolidated Appropriations Resolution, 2003 (Public Law 108–7).
- (d) **Administration of assistance—**
  - (1) Assistance under this part shall be administered so as to give particular attention to the interrelationship between (A) population growth, and (B) development and overall improvement in living standards in developing countries, and to the impact of all [programs](/usc/22/3383.md?p=6), projects, and activities on population growth. All appropriate activities proposed for financing under this part shall be designed to build motivation for smaller [families](/usc/22/4304a.md?p=c-2) through modification of economic and social conditions supportive of the desire for large [families](/usc/22/4304a.md?p=c-2), in [programs](/usc/22/3383.md?p=6) such as education in and out of school, nutrition, disease control, maternal and child health services, improvements in the status and employment of women, agricultural production, rural development, and assistance to the urban poor, and through community-based development [programs](/usc/22/3383.md?p=6) which give recognition to people motivated to limit the size of their [families](/usc/22/4304a.md?p=c-2). Population planning [programs](/usc/22/3383.md?p=6) shall be coordinated with other [programs](/usc/22/3383.md?p=6) aimed at reducing the infant mortality rate, providing better nutrition for pregnant women and infants, and raising the standard of living of the poor.
  - (2) Since the problems of malnutrition, disease, and rapid population growth are closely related, planning for assistance to be provided under subsections [(b)](#b) and [(c)](#c) of this section and under [section 2151a of this title](/usc/22/2151a.md) shall be coordinated to the maximum extent practicable.
  - (3) Assistance provided under this section shall emphasize low-cost integrated delivery systems for health, nutrition, and [family](/usc/22/4304a.md?p=c-2) planning for the poorest people, with particular attention to the needs of mothers and young children, using paramedical and auxiliary medical personnel, clinics and health posts, commercial distribution systems, and other modes of community outreach.
- (e) **Research and analysis—**
  - (1) Health and population research and analysis carried out under this chapter shall—
    - (A) be undertaken to the maximum extent practicable in developing countries by developing country personnel, linked as appropriate with private and governmental biomedical research [facilities](/usc/22/2431a.md?p=8) within the [United States](/usc/22/1395.md?p=a-1);
    - (B) take account of the special needs of the poor people of developing countries in the determination of research priorities; and
    - (C) make extensive use of field testing to adapt basic research to local conditions.
  - (2) The President is authorized to study the complex factors affecting population growth in developing countries and to identify factors which might motivate people to plan [family](/usc/22/4304a.md?p=c-2) size or to space their children.
- (f) **Prohibition on use of funds for performance or research respecting abortions or involuntary sterilization—**
  - (1) None of the [funds](/usc/22/2431a.md?p=9) made available to carry out subchapter I of this chapter may be used to pay for the performance of abortions as a method of [family](/usc/22/4304a.md?p=c-2) planning or to motivate or coerce any person to practice abortions.
  - (2) None of the [funds](/usc/22/2431a.md?p=9) made available to carry out subchapter I of this chapter may be used to pay for the performance of involuntary sterilizations as a method of [family](/usc/22/4304a.md?p=c-2) planning or to coerce or provide any financial incentive to any person to undergo sterilizations.
  - (3) None of the [funds](/usc/22/2431a.md?p=9) made available to carry out subchapter I of this chapter may be used to pay for any biomedical research which relates, in whole or in part, to methods of, or the performance of, abortions or involuntary sterilization as a means of [family](/usc/22/4304a.md?p=c-2) planning.
- (g) **Authorization of appropriations—**
  - (1) There are authorized to be appropriated to the President, in addition to [funds](/usc/22/2431a.md?p=9) otherwise available for such purposes—
    - (A) $290,000,000 for fiscal year 1986 and $290,000,000 for fiscal year 1987 to carry out [subsection (b)](#b) of this section; and
    - (B) $205,000,000 for fiscal year 1986 and $180,000,000 for fiscal year 1987 to carry out [subsection (c)](#c) of this section.
  - (2) [Funds](/usc/22/2431a.md?p=9) appropriated under this subsection are authorized to remain available until expended.

# §2151b–1. Assistance for malaria prevention, treatment, control, and elimination

- (a) **Assistance—**
  - (1) **In general—** The [Administrator](/usc/22/277d–43.md?p=1) of the [United States](/usc/22/1395.md?p=a-1) Agency for International Development, in coordination with the heads of other appropriate Federal agencies and nongovernmental organizations, shall provide assistance for the establishment and conduct of activities designed to prevent, treat, control, and eliminate malaria in countries with a high percentage of malaria cases.
  - (2) **Consideration of interaction among epidemics—** In providing assistance pursuant to [paragraph (1)](#a-1), the [Administrator](/usc/22/277d–43.md?p=1) should consider the interaction among the epidemics of [HIV/AIDS](/usc/22/2152f.md?p=b-3), malaria, and tuberculosis.
  - (3) **Dissemination of information requirement—** Activities referred to in [paragraph (1)](#a-1) shall include the dissemination of information relating to the development of vaccines and therapeutic agents for the prevention of malaria (including information relating to participation in, and the results of, clinical trials for such vaccines and agents conducted by [United States](/usc/22/1395.md?p=a-1) Government agencies) to appropriate officials in such countries.
- (b) **Authorization of appropriations—**
  - (1) **In general—** There are authorized to be appropriated to carry out [subsection (a)](#a) $50,000,000 for each of the fiscal years 2001 and 2002.
  - (2) **Availability—** Amounts appropriated pursuant to the authorization of appropriations under [paragraph (1)](#b-1) are authorized to remain available until expended.

# §2151b–2. Assistance to combat HIV/AIDS

- (a) **Finding—** Congress recognizes that the alarming spread of [HIV/AIDS](#h-3) in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America and other developing countries is a major global health, national security, development, and humanitarian crisis.
- (b) **Policy—**
  - (1) **Objectives—** It is a major objective of the [foreign assistance](/usc/22/2394.md?p=b-1) [program](/usc/22/3383.md?p=6) of the [United States](/usc/22/1395.md?p=a-1) to provide assistance for the prevention and treatment of [HIV/AIDS](#h-3) and the care of those affected by the disease. It is the policy objective of the [United States](/usc/22/1395.md?p=a-1), by 2013, to—
    - (A) assist partner countries to—
      - (i) prevent 12,000,000 new [HIV](#h-2) infections worldwide;
      - (ii) support—
        - (I) the increase in the number of individuals with [HIV/AIDS](#h-3) receiving antiretroviral treatment above the goal established under [section 7672(a)(3)](/usc/22/7672.md?p=a-3)[^1] of this title and increased pursuant to [paragraphs (1) through (3)](/usc/22/7673.md?p=d-1..d-3) of section 7673(d)[^1] of this title; and
        - (II) additional treatment through coordinated multilateral efforts;
      - (iii) support care for 12,000,000 individuals infected with or affected by [HIV/AIDS](#h-3), including 5,000,000 orphans and vulnerable children affected by [HIV/AIDS](#h-3), with an emphasis on promoting a comprehensive, coordinated system of services to be integrated throughout the continuum of care;
      - (iv) provide at least 80 percent of the target population with access to counseling, testing, and treatment to prevent the transmission of [HIV](#h-2) from mother-to-child;
      - (v) provide care and treatment services to children with [HIV](#h-2) in proportion to their percentage within the [HIV](#h-2)-infected population of a given partner country; and
      - (vi) train and support retention of health care professionals, paraprofessionals, and community health workers in [HIV/AIDS](#h-3) prevention, treatment, and care, with the target of providing such [training](/usc/22/8921.md?p=3) to at least 140,000 new health care professionals and paraprofessionals with an emphasis on [training](/usc/22/8921.md?p=3) and in country deployment of critically needed doctors and nurses;
    - (B) strengthen the capacity to deliver primary health care in developing countries, especially in sub-Saharan Africa;
    - (C) support and help countries in their efforts to achieve staffing levels of at least 2.3 doctors, nurses, and midwives per 1,000 population, as called for by the World Health Organization; and
    - (D) help partner countries to develop independent, sustainable [HIV/AIDS](#h-3) [programs](/usc/22/3383.md?p=6).
  - (2) **Coordinated global strategy—** The [United States](/usc/22/1395.md?p=a-1) and other countries with the sufficient capacity should provide assistance to countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, and Latin America, and other countries and regions confronting [HIV/AIDS](#h-3) epidemics in a coordinated global strategy to help address generalized and concentrated epidemics through [HIV/AIDS](#h-3) prevention, treatment, care, monitoring and evaluation, and related activities.
  - (3) **Priorities—** The [United States](/usc/22/1395.md?p=a-1) Government’s response to the global [HIV/AIDS](#h-3) pandemic and the Government’s efforts to help countries assume leadership of sustainable campaigns to combat their local epidemics should place high priority on—
    - (A) the prevention of the transmission of [HIV](#h-2);
    - (B) moving toward universal access to [HIV/AIDS](#h-3) prevention counseling and services;
    - (C) the inclusion of cost sharing assurances that meet the requirements under [section 2151h of this title](/usc/22/2151h.md); and
    - (D) the inclusion of transition strategies to ensure sustainability of such [programs](/usc/22/3383.md?p=6) and activities, including health care systems, under other international donor support, or budget support by respective [foreign](/usc/22/3146.md?p=1) governments.
- (c) **Authorization—**
  - (1) **In general—** Consistent with [section 2151b(c) of this title](/usc/22/2151b.md?p=c), the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for [HIV/AIDS](#h-3), including to prevent, treat, and monitor [HIV/AIDS](#h-3), and carry out related activities, in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America, and other countries and areas, particularly with respect to refugee populations or those in postconflict settings in such countries and areas with significant or increasing [HIV](#h-2) incidence rates.
  - (2) **Role of NGOs—** It is the sense of Congress that the President should provide an appropriate level of assistance under [paragraph (1)](#c-1) through nongovernmental organizations (including faith-based and community-based organizations) in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America, and other countries and areas affected by the [HIV/AIDS](#h-3) pandemic, particularly with respect to refugee populations or those in post-conflict settings in such countries and areas with significant or increasing [HIV](#h-2) incidence rates..[^2]
  - (3) **Coordination of assistance efforts—** The President shall coordinate the provision of assistance under [paragraph (1)](#c-1) with the provision of related assistance by the Joint United Nations Programme on [HIV/AIDS](#h-3) (UNAIDS), the United Nations Children’s [Fund](/usc/22/2431a.md?p=9) (UNICEF), the World Health Organization (WHO), the United Nations Development Programme (UNDP), the Global [Fund](/usc/22/2431a.md?p=9) to Fight [AIDS](#h-1), Tuberculosis and Malaria and other appropriate [international organizations](/usc/22/4316.md?p=e-2) (such as the International Bank for Reconstruction and Development), relevant regional [multilateral development institutions](/usc/22/262r.md?p=c-3), national, state, and local governments of partner countries, other international actors,,[^2] appropriate governmental and nongovernmental organizations, and [relevant executive branch agencies](#h-4) within the framework of the principles of the Three Ones.
- (d) **Activities supported—** Assistance provided under [subsection (c)](#c) shall, to the maximum extent practicable, be used to carry out the following activities:
  - (1) **Prevention—** Prevention of [HIV/AIDS](#h-3) through activities including—
    - (A) [programs](/usc/22/3383.md?p=6) and efforts that are designed or intended to impart knowledge with the exclusive purpose of helping individuals avoid behaviors that place them at risk of [HIV](#h-2) infection, including integration of such [programs](/usc/22/3383.md?p=6) into health [programs](/usc/22/3383.md?p=6) and the inclusion in counseling [programs](/usc/22/3383.md?p=6) of information on methods of avoiding infection of [HIV](#h-2), including delaying sexual debut, abstinence, fidelity and monogamy, reduction of casual sexual partnering and multiple concurrent sexual partnering,,[^2] reducing sexual violence and coercion, including child marriage, widow inheritance, and polygamy, and where appropriate, use of male and female condoms;
    - (B) assistance to establish and implement culturally appropriate [HIV/AIDS](#h-3) education and prevention [programs](/usc/22/3383.md?p=6) that are designed with local input and focus on helping individuals avoid infection of [HIV/AIDS](#h-3), implemented through nongovernmental organizations, including faith-based and community-based organizations, particularly those locally based organizations that utilize both professionals and volunteers with appropriate skills, experience, and community presence;
    - (C) assistance for the purpose of encouraging men to be responsible in their sexual behavior, child rearing, and to respect women;
    - (D) assistance for the purpose of providing voluntary testing and counseling (including the incorporation of confidentiality protections with respect to such testing and counseling) and promoting the use of provider-initiated or “opt-out” voluntary testing in accordance with World Health Organization guidelines;
    - (E) assistance for the purpose of preventing mother-to-child transmission of the [HIV](#h-2) infection, including medications to prevent such transmission and access to infant formula and other alternatives for infant feeding;
    - (F) assistance to—
      - (i) achieve the goal of reaching 80 percent of pregnant women for prevention and treatment of mother-to-child transmission of [HIV](#h-2) in countries in which the [United States](/usc/22/1395.md?p=a-1) is implementing [HIV/AIDS](#h-3) [programs](/usc/22/3383.md?p=6) by 2013; and
      - (ii) promote infant feeding options and treatment protocols that meet the most recent criteria established by the World Health Organization;
    - (G) medical male circumcision [programs](/usc/22/3383.md?p=6) as part of national strategies to combat the transmission of [HIV/AIDS](#h-3);
    - (H) assistance to ensure a safe blood supply and sterile medical equipment;
    - (I) assistance to help avoid substance abuse and intravenous drug use that can lead to [HIV](#h-2) infection;
    - (J) assistance for the purpose of increasing women’s access to employment opportunities, income, productive resources, and microfinance [programs](/usc/22/3383.md?p=6), where appropriate.[^3]
    - (K) assistance for counseling, testing, treatment, care, and support [programs](/usc/22/3383.md?p=6), including—
      - (i) counseling and other services for the prevention of reinfection of individuals with [HIV/AIDS](#h-3);
      - (ii) counseling to prevent sexual transmission of [HIV](#h-2), including—
        - (I) life skills development for practicing abstinence and faithfulness;
        - (II) reducing the number of sexual partners;
        - (III) delaying sexual debut; and
        - (IV) ensuring correct and consistent use of condoms;
      - (iii) assistance to engage underlying vulnerabilities to [HIV/AIDS](#h-3), especially those of women and girls;
      - (iv) assistance for appropriate [HIV/AIDS](#h-3) education [programs](/usc/22/3383.md?p=6) and [training](/usc/22/8921.md?p=3) targeted to prevent the transmission of [HIV](#h-2) among men who have sex with men;
      - (v) assistance to provide male and female condoms;
      - (vi) diagnosis and treatment of other sexually transmitted infections;
      - (vii) strategies to address the stigma and discrimination that impede [HIV/AIDS](#h-3) prevention efforts; and
      - (viii) assistance to facilitate widespread access to microbicides for [HIV](#h-2) prevention, if safe and effective products become available, including financial and technical support for culturally appropriate introductory [programs](/usc/22/3383.md?p=6), procurement, distribution, logistics management, [program](/usc/22/3383.md?p=6) delivery, acceptability studies, provider [training](/usc/22/8921.md?p=3), demand generation, and postintroduction monitoring.
  - (2) **Treatment—** The treatment and care of individuals with [HIV/AIDS](#h-3), including—
    - (A) assistance to establish and implement [programs](/usc/22/3383.md?p=6) to strengthen and broaden indigenous health care delivery systems and the capacity of such systems to deliver [HIV/AIDS](#h-3) pharmaceuticals and otherwise provide for the treatment of individuals with [HIV/AIDS](#h-3), including clinical [training](/usc/22/8921.md?p=3) for indigenous organizations and health care providers;
    - (B) assistance to strengthen and expand hospice and palliative care [programs](/usc/22/3383.md?p=6) to assist patients debilitated by [HIV/AIDS](#h-3), their [families](/usc/22/4304a.md?p=c-2), and the primary caregivers of such patients, including [programs](/usc/22/3383.md?p=6) that utilize faith-based and community-based organizations;
    - (C) assistance for the purpose of the care and treatment of individuals with [HIV/AIDS](#h-3) through the provision of pharmaceuticals, including antiretrovirals and other pharmaceuticals and therapies for the treatment of opportunistic infections, pain management, nutritional support, and other treatment modalities;
    - (D) as part of care and treatment of [HIV/AIDS](#h-3), assistance (including prophylaxis and treatment) for common [HIV/AIDS](#h-3)-related opportunistic infections for free or at a rate at which it is easily affordable to the individuals and populations being served;[^4]
    - (E) as part of care and treatment of [HIV/AIDS](#h-3), assistance or referral to available and adequately resourced service providers for nutritional support, including counseling and where necessary the provision of [commodities](/usc/22/2403.md?p=c), for persons meeting malnourishment criteria and their [families](/usc/22/4304a.md?p=c-2);[^5]
  - (3) **Preventative intervention education and technologies—**
    - (A) With particular emphasis on specific populations that represent a particularly high risk of contracting or spreading [HIV/AIDS](#h-3), including those exploited through the sex trade, victims of rape and sexual assault, individuals already infected with [HIV/AIDS](#h-3), and in cases of occupational exposure of health care workers, assistance with efforts to reduce the risk of [HIV/AIDS](#h-3) infection including post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and [commodities](/usc/22/2403.md?p=c), including test kits, condoms, and, when proven effective, microbicides.
    - (B) Bulk purchases of available test kits, condoms, and, when proven effective, microbicides that are intended to reduce the risk of [HIV/AIDS](#h-3) transmission and for appropriate [program](/usc/22/3383.md?p=6) support for the introduction and distribution of these [commodities](/usc/22/2403.md?p=c), as well as education and [training](/usc/22/8921.md?p=3) on the use of the technologies.
  - (4) **Monitoring—** The monitoring of [programs](/usc/22/3383.md?p=6), projects, and activities carried out pursuant to [paragraphs (1) through (3)](#d-1..d-3), including—
    - (A) monitoring to ensure that adequate controls are established and implemented to provide [HIV/AIDS](#h-3) pharmaceuticals and other appropriate medicines to poor individuals with [HIV/AIDS](#h-3);
    - (B) appropriate evaluation and surveillance activities;
    - (C) monitoring to ensure that appropriate measures are being taken to maintain the sustainability of [HIV/AIDS](#h-3) pharmaceuticals (especially antiretrovirals) and ensure that drug resistance is not compromising the benefits of such pharmaceuticals;
    - (D) monitoring to ensure appropriate law enforcement officials are working to ensure that [HIV/AIDS](#h-3) pharmaceuticals are not diminished through illegal counterfeiting or black market sales of such pharmaceuticals;
    - (E) carrying out and expanding [program](/usc/22/3383.md?p=6) monitoring, impact evaluation research and analysis, and operations research and disseminating data and findings through mechanisms to be developed by the Coordinator of [United States](/usc/22/1395.md?p=a-1) Government Activities to Combat [HIV/AIDS](#h-3) Globally, in coordination with the Director of the Centers for Disease Control, in order to—
      - (i) improve accountability, increase transparency, and ensure the delivery of evidence-based services through the collection, evaluation, and analysis of data regarding gender-responsive interventions, disaggregated by age and sex;
      - (ii) identify and replicate effective models; and
      - (iii) develop gender indicators to measure outcomes and the impacts of interventions; and
    - (F) establishing appropriate systems to—
      - (i) gather epidemiological and social science data on [HIV](#h-2); and
      - (ii) evaluate the effectiveness of prevention efforts among men who have sex with men, with due consideration to stigma and risks associated with disclosure.
  - (5) **Pharmaceuticals—**
    - (A) **Procurement—** The procurement of [HIV/AIDS](#h-3) pharmaceuticals, antiviral therapies, and other appropriate medicines, including medicines to treat opportunistic infections.
    - (B) **Mechanisms for quality control and sustainable supply—** Mechanisms to ensure that such [HIV/AIDS](#h-3) pharmaceuticals, antiretroviral therapies, and other appropriate medicines are quality-controlled and sustainably supplied.
    - (C) **Mechanism to ensure cost-effective drug purchasing—** Subject to [subparagraph (B)](#d-5-B), mechanisms to ensure that safe and effective pharmaceuticals, including antiretrovirals and medicines to treat opportunistic infections, are purchased at the lowest possible price at which such pharmaceuticals may be obtained in sufficient quantity on the world market, provided that such pharmaceuticals are approved, tentatively approved, or otherwise authorized for use by—
      - (i) the Food and Drug Administration;
      - (ii) a stringent regulatory agency acceptable to the [Secretary](/usc/22/277d–43.md?p=5) of Health and Human Services; or
      - (iii) a quality assurance mechanism acceptable to the [Secretary](/usc/22/277d–43.md?p=5) of Health and Human Services.
    - (D) **Distribution—** The distribution of such [HIV/AIDS](#h-3) pharmaceuticals, antiviral therapies, and other appropriate medicines (including medicines to treat opportunistic infections) to qualified national, regional, or local organizations for the treatment of individuals with [HIV/AIDS](#h-3) in accordance with appropriate [HIV/AIDS](#h-3) testing and monitoring requirements and treatment protocols and for the prevention of mother-to-child transmission of the [HIV](#h-2) infection.
  - (6) **Related and coordinated activities—** The conduct of related activities, including—
    - (A) the care and support of children who are orphaned by the [HIV/AIDS](#h-3) pandemic, including services designed to care for orphaned children in a [family](/usc/22/4304a.md?p=c-2) environment which rely on extended [family](/usc/22/4304a.md?p=c-2) members;
    - (B) improved infrastructure and institutional capacity to develop and manage education, prevention, and treatment [programs](/usc/22/3383.md?p=6), including [training](/usc/22/8921.md?p=3) and the resources to collect and maintain accurate [HIV](#h-2) surveillance data to target [programs](/usc/22/3383.md?p=6) and measure the effectiveness of interventions;
    - (C) vaccine research and development partnership [programs](/usc/22/3383.md?p=6) with specific plans of action to develop a safe, effective, accessible, preventive [HIV](#h-2) vaccine for use throughout the world; and[^6]
    - (D) coordinated or referred activities to—
      - (i) enhance the clinical impact of [HIV/AIDS](#h-3) care and treatment; and
      - (ii) ameliorate the adverse social and economic costs often affecting [AIDS](#h-1)-impacted [families](/usc/22/4304a.md?p=c-2) and communities through the direct provision, as necessary, or through the referral, if possible, of support services, including—
        - (I) nutritional and food support;
        - (II) safe drinking water and adequate sanitation;
        - (III) nutritional counseling;
        - (IV) income-generating activities and livelihood initiatives;
        - (V) maternal and child health care;
        - (VI) primary health care;
        - (VII) the diagnosis and treatment of other infectious or sexually transmitted diseases;
        - (VIII) substance abuse and treatment services; and
        - (IX) legal services;
    - (E) coordinated or referred activities to link [programs](/usc/22/3383.md?p=6) addressing [HIV/AIDS](#h-3) with [programs](/usc/22/3383.md?p=6) addressing gender-based violence in areas of significant [HIV](#h-2) prevalence to assist countries in the development and enforcement of women’s health, children’s health, and [HIV/AIDS](#h-3) laws and policies that—
      - (i) prevent and respond to violence against women and girls;
      - (ii) promote the integration of screening and assessment for gender-based violence into [HIV/AIDS](#h-3) programming;
      - (iii) promote appropriate [HIV/AIDS](#h-3) counseling, testing, and treatment into gender-based violence [programs](/usc/22/3383.md?p=6); and
      - (iv) assist governments to develop partnerships with civil society organizations to create networks for psychosocial, legal, economic, or other support services;
    - (F) coordinated or referred activities to—
      - (i) address the frequent coinfection of [HIV](#h-2) and tuberculosis, in accordance with World Health Organization guidelines;
      - (ii) promote provider-initiated or “opt-out” [HIV/AIDS](#h-3) counseling and testing and appropriate referral for treatment and care to individuals with tuberculosis or its symptoms, particularly in areas with significant [HIV](#h-2) prevalence; and
      - (iii) strengthen [programs](/usc/22/3383.md?p=6) to ensure that individuals testing positive for [HIV](#h-2) receive tuberculosis screening and to improve laboratory capacities, infection control, and adherence; and
    - (G) activities to—
      - (i) improve the effectiveness of national responses to [HIV/AIDS](#h-3);
      - (ii) strengthen overall health systems in high-prevalence countries, including support for workforce [training](/usc/22/8921.md?p=3), retention, and effective deployment, capacity building, laboratory development, equipment maintenance and repair, and public health and related public financial management systems and operations; and
      - (iii) encourage fair and transparent procurement practices among partner countries; and
      - (iv) promote in-country or intra-regional pediatric [training](/usc/22/8921.md?p=3) for physicians and other health professionals, preferably through public-private partnerships involving colleges and universities, with the goal of increasing pediatric [HIV](#h-2) workforce capacity.
  - (7) **Comprehensive HIV/AIDS public-private partnerships—** The establishment and operation of public-private partnership entities within countries in sub-Saharan Africa, the Caribbean, and other countries affected by the [HIV/AIDS](#h-3) pandemic that are dedicated to supporting the national strategy of such countries regarding the prevention, treatment, and monitoring of [HIV/AIDS](#h-3). Each such public-private partnership should—
    - (A) support the development, implementation, and management of comprehensive [HIV/AIDS](#h-3) plans in support of the national [HIV/AIDS](#h-3) strategy;
    - (B) operate at all times in a manner that emphasizes efficiency, accountability, and results-driven [programs](/usc/22/3383.md?p=6);
    - (C) engage both local and [foreign](/usc/22/3146.md?p=1) development partners and donors, including businesses, government agencies, academic institutions, nongovernmental organizations, [foundations](/usc/22/10601.md?p=6), multilateral development agencies, and faith-based organizations, to assist the country in coordinating and implementing [HIV/AIDS](#h-3) prevention, treatment, and monitoring [programs](/usc/22/3383.md?p=6) in accordance with its national [HIV/AIDS](#h-3) strategy;
    - (D) provide technical assistance, consultant services, financial planning, monitoring and evaluation, and research in support of the national [HIV/AIDS](#h-3) strategy; and
    - (E) establish local human resource capacities for the national [HIV/AIDS](#h-3) strategy through the transfer of medical, managerial, leadership, and technical skills.
  - (8) **Compacts and framework agreements—** The development of [compacts](/usc/22/7702.md?p=5) or framework [agreements](/usc/22/2431a.md?p=7), tailored to local circumstances, with national governments or regional partnerships in countries with significant [HIV/AIDS](#h-3) burdens to promote host government commitment to deeper integration of [HIV/AIDS](#h-3) services into health systems, contribute to health systems overall, and enhance sustainability, including—
    - (A) cost sharing assurances that meet the requirements under [section 2151h of this title](/usc/22/2151h.md); and
    - (B) transition strategies to ensure sustainability of such [programs](/usc/22/3383.md?p=6) and activities, including health care systems, under other international donor support, or budget support by respective [foreign](/usc/22/3146.md?p=1) governments.
- (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](#h-1) Initiative] should squarely address the needs and challenges involved in supporting sustainable country [HIV/AIDS](#h-3) [programs](/usc/22/3383.md?p=6), 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](#h-3) is through [compacts](/usc/22/7702.md?p=5) or framework [agreements](/usc/22/2431a.md?p=7) between the [United States](/usc/22/1395.md?p=a-1) Government and each participating nation.
  - (2) **Elements—** [Compacts](/usc/22/7702.md?p=5) on [HIV/AIDS](#h-3) authorized under [subsection (d)(8)](#d-8) shall include the following elements:
    - (A) [Compacts](/usc/22/7702.md?p=5) whose primary purpose is to provide direct services to combat [HIV/AIDS](#h-3) are to be made between—
      - (i) the [United States](/usc/22/1395.md?p=a-1) Government; and
      - (ii)
        - (I) national or regional entities representing low-income countries served by an existing [United States](/usc/22/1395.md?p=a-1) 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](#h-2) prevalence or risk of significantly increasing incidence within the general population;
          - (bb) served by an existing [United States](/usc/22/1395.md?p=a-1) 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](/usc/22/7702.md?p=5) 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](/usc/22/1395.md?p=a-1) Agency for International Development or Department of Health and Human Services presence or regional platform;
      - (ii) shall require significant investments in [HIV](#h-2) prevention, care, and treatment services by the host country;
      - (iii) shall be time-limited in terms of [United States](/usc/22/1395.md?p=a-1) contributions; and
      - (iv) shall be made only upon prior notification to Congress—
        - (I) justifying the need for such [compacts](/usc/22/7702.md?p=5);
        - (II) describing the expected investment by the country or regional entity; and
        - (III) describing the scope, nature, expected total [United States](/usc/22/1395.md?p=a-1) investment, and time frame of the limited technical assistance under the [compact](/usc/22/7702.md?p=5) and its intended impact.
    - (C) [Compacts](/usc/22/7702.md?p=5) shall include provisions to—
      - (i) promote local and national efforts to reduce stigma associated with [HIV/AIDS](#h-3); and
      - (ii) work with and promote the role of civil society in combating [HIV/AIDS](#h-3).
    - (D) [Compacts](/usc/22/7702.md?p=5) shall take into account the overall national health and development and national [HIV/AIDS](#h-3) and public health strategies of each country.
    - (E) [Compacts](/usc/22/7702.md?p=5) shall contain—
      - (i) consideration of the specific objectives that the country and the [United States](/usc/22/1395.md?p=a-1) expect to achieve during the term of a [compact](/usc/22/7702.md?p=5);
      - (ii) consideration of the respective responsibilities of the country and the [United States](/usc/22/1395.md?p=a-1) 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](/usc/22/7702.md?p=5) is intended to—
        - (I) address the factors that put women and girls at greater risk of [HIV/AIDS](#h-3); 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](/usc/22/7702.md?p=5) will—
        - (I) strengthen the health care capacity, including factors such as the [training](/usc/22/8921.md?p=3), 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](/usc/22/7702.md?p=5) participants to maintain and operate equipment transferred or purchased as part of the [compact](/usc/22/7702.md?p=5);
      - (vii) consideration of proposed mechanisms to provide oversight;
      - (viii) consideration of the role of civil society in the development of a [compact](/usc/22/7702.md?p=5) 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](/usc/22/7702.md?p=5), priority shall be given to countries that are included in regional [funds](/usc/22/2431a.md?p=9) and [programs](/usc/22/3383.md?p=6) in existence as of July 30, 2008.
    - (G) Amounts made available for [compacts](/usc/22/7702.md?p=5) described in subparagraphs [(A)](#e-2-A) and [(B)](#e-2-B) shall be subject to the inclusion of—
      - (i) cost sharing assurances that meet the requirements under [section 2151h of this title](/usc/22/2151h.md); and
      - (ii) transition strategies to ensure sustainability of such [programs](/usc/22/3383.md?p=6) and activities, including health care systems, under other international donor support, and budget support by respective [foreign](/usc/22/3146.md?p=1) governments.
  - (3) **Local input—** In entering into a [compact](/usc/22/7702.md?p=5) on [HIV/AIDS](#h-3) authorized under [subsection (d)(8)](#d-8), the Coordinator of [United States](/usc/22/1395.md?p=a-1) Government Activities to Combat [HIV/AIDS](#h-3) 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](/usc/22/7702.md?p=5) authorized under [subsection (d)(8)](#d-8), the Global [AIDS](#h-1) Coordinator shall—
    - (A) submit a report containing a detailed summary of the [compact](/usc/22/7702.md?p=5) and a copy of the text of the [compact](/usc/22/7702.md?p=5) to—
      - (i) the Committee on [Foreign](/usc/22/3146.md?p=1) Relations of the Senate;
      - (ii) the Committee on Appropriations of the Senate;
      - (iii) the Committee on [Foreign](/usc/22/3146.md?p=1) 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](/usc/22/2214a.md?p=9) of the Global [AIDS](#h-1) Coordinator.
- (f) **Annual report—**
  - (1) **In general—** Not later than February 15, 2014, and annually thereafter, the President shall submit to the Committee on [Foreign](/usc/22/3146.md?p=1) Relations of the Senate and the Committee on [Foreign](/usc/22/3146.md?p=1) Affairs of the House of Representatives a report in an open, machine readable format, on the implementation of this section for the prior fiscal year.
  - (2) **Report due in 2014—** The report due not later than February 15, 2014, shall include the elements required by law prior to the enactment of the PEPFAR Stewardship and Oversight Act of 2013.
  - (3) **Report elements—** Each report submitted after February 15, 2014, shall include the following:
    - (A) A description based on internationally available data, and where practicable high-quality country-based data, of the total global burden and need for [HIV/AIDS](#h-3) prevention, treatment, and care, including—
      - (i) estimates by [partner country](#f-5) of the global burden and need; and
      - (ii) [HIV](#h-2) incidence, prevalence, and [AIDS](#h-1) deaths for the reporting period.
    - (B) Reporting on annual targets across prevention, treatment, and care interventions in [partner countries](#f-5), including—
      - (i) a description of how those targets are designed to—
        - (I) ensure that the annual increase in new patients on antiretroviral treatment exceeds the number of annual new [HIV](#h-2) infections;
        - (II) reduce the number of new [HIV](#h-2) infections below the number of deaths among persons infected with [HIV](#h-2); and
        - (III) achieve an [AIDS](#h-1)-free generation;
      - (ii) national targets across prevention, treatment, and care that are—
        - (I) established by [partner countries](#f-5); or
        - (II) where such national [partner country](#f-5)-developed targets are unavailable, a description of progress towards developing national [partner country](#f-5) targets; and
      - (iii) bilateral programmatic targets across prevention, treatment, and care, including—
        - (I) the number of adults and children to be directly supported on [HIV](#h-2) treatment under [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6);
        - (II) the number of adults and children to be otherwise supported on [HIV](#h-2) treatment under [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6); and
        - (III) other programmatic targets for activities directly and otherwise supported by [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6).
    - (C) A description, by [partner country](#f-5), of [HIV/AIDS](#h-3) funding from all sources, including funding levels from [partner countries](#f-5), other donors, and the private sector, as practicable.
    - (D) A description of how [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6), in conjunction with the Global [Fund](/usc/22/2431a.md?p=9), other donors, and [partner countries](#f-5), together set targets, measure progress, and achieve positive outcomes in [partner countries](#f-5).
    - (E) An annual assessment of outcome indicator development, dissemination, and performance for [programs](/usc/22/3383.md?p=6) supported under this section, including ongoing corrective actions to improve reporting.
    - (F) A description and explanation of changes in related guidance or policies related to implementation of [programs](/usc/22/3383.md?p=6) supported under this section.
    - (G) An assessment and quantification of progress over the reporting period toward achieving the targets set forth in [subparagraph (B)](#f-3-B), including—
      - (i) the number, by [partner country](#f-5), of persons on [HIV](#h-2) treatment, including specifically—
        - (I) the number of adults and children on [HIV](#h-2) treatment directly supported by [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6); and
        - (II) the number of adults and children on [HIV](#h-2) treatment otherwise supported by [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6);
      - (ii) [HIV](#h-2) treatment coverage rates by [partner country](#f-5);
      - (iii) the net increase in persons on [HIV](#h-2) treatment by [partner country](#f-5);
      - (iv) new infections of [HIV](#h-2) by [partner country](#f-5);
      - (v) the number of [HIV](#h-2) infections averted;
      - (vi) antiretroviral treatment [program](/usc/22/3383.md?p=6) retention rates by [partner country](#f-5), including—
        - (I) performance against annual targets for [program](/usc/22/3383.md?p=6) retention; and
        - (II) the retention rate of persons on [HIV](#h-2) treatment directly supported by [United States](/usc/22/1395.md?p=a-1)-funded [programs](/usc/22/3383.md?p=6); and
      - (vii) a description of supportive care.
    - (H) A description of [partner country](#f-5) and [United States](/usc/22/1395.md?p=a-1)-funded [HIV/AIDS](#h-3) prevention [programs](/usc/22/3383.md?p=6) and policies, including—
      - (i) an assessment by country of progress towards targets set forth in [subparagraph (B)](#f-3-B), with a detailed description of the metrics used to assess—
        - (I) [programs](/usc/22/3383.md?p=6) to prevent mother to child transmission of [HIV/AIDS](#h-3), including coverage rates;
        - (II) [programs](/usc/22/3383.md?p=6) to provide or promote voluntary medical male circumcision, including coverage rates;
        - (III) [programs](/usc/22/3383.md?p=6) for behavior-change; and
        - (IV) other programmatic activities to prevent the transmission of [HIV](#h-2);
      - (ii) antiretroviral treatment as prevention; and
      - (iii) a description of any new preventative interventions or methodologies.
    - (I) A description of the goals, scope, and measurement of [program](/usc/22/3383.md?p=6) efforts aimed at women and girls.
    - (J) A description of the goals, scope, and measurement of [program](/usc/22/3383.md?p=6) efforts aimed at orphans, vulnerable children, and youth.
    - (K) A description of the indicators and milestones used to assess effective, strategic, and appropriately timed country ownership, including—
      - (i) an explanation of the metrics used to determine whether the pace of any transition to such ownership is appropriate for that country, given that country’s level of readiness for such transition;
      - (ii) an analysis of governmental and local nongovernmental capacity to sustain positive outcomes;
      - (iii) a description of measures taken to improve [partner country](#f-5) capacity to sustain positive outcomes where needed; and
      - (iv) for countries undergoing a transition to greater country ownership, a description of strategies to assess and mitigate programmatic and financial risk and to ensure continued quality of care for essential services.
    - (L) A description, globally and by [partner country](#f-5), of specific efforts to achieve and incentivize greater programmatic and cost effectiveness, including—
      - (i) progress toward establishing common economic metrics across prevention, care and treatment with [partner countries](#f-5) and the Global [Fund](/usc/22/2431a.md?p=9);
      - (ii) average costs, by country and by core intervention;
      - (iii) expenditure reporting in all [program](/usc/22/3383.md?p=6) areas, supplemented with targeted analyses of the cost-effectiveness of specific interventions; and
      - (iv) import duties and internal taxes imposed on [program](/usc/22/3383.md?p=6) [commodities](/usc/22/2403.md?p=c) and services, by country.
    - (M) A description of partnership framework [agreements](/usc/22/2431a.md?p=7) with countries, and regions where applicable, including—
      - (i) the objectives and structure of partnership framework [agreements](/usc/22/2431a.md?p=7) with countries, including—
        - (I) how these [agreements](/usc/22/2431a.md?p=7) are aligned with national [HIV/AIDS](#h-3) plans and public health strategies and commitments of such countries; and
        - (II) how these [agreements](/usc/22/2431a.md?p=7) incorporate a role for civil society; and
      - (ii) a description of what has been learned in advancing partnership framework [agreements](/usc/22/2431a.md?p=7) with countries, and regions as applicable, in terms of improved coordination and collaboration, definition of clear roles and responsibilities of participants and signers, and implications for how to further strengthen these [agreements](/usc/22/2431a.md?p=7) with mutually accountable measures of progress.
    - (N) A description of efforts and activities to engage new partners, including faith-based, locally-based, and [United States](/usc/22/1395.md?p=a-1) minority-serving institutions.
    - (O) A definition and description of the differentiation between directly and otherwise supported activities, including specific efforts to clarify programmatic attribution and contribution, as well as timelines for dissemination and implementation.
    - (P) A description, globally and by country, of specific efforts to address co-infections and co-morbidities of [HIV/AIDS](#h-3), including—
      - (i) the number and percent of people in [HIV](#h-2) care or treatment who started tuberculosis treatment; and
      - (ii) the number and percentage of eligible [HIV](#h-2) positive patients starting isoniazid preventative therapy.
    - (Q) A description of efforts by [partner countries](#f-5) to train, employ, and retain health care workers, including efforts to address workforce shortages.
    - (R) A description of [program](/usc/22/3383.md?p=6) evaluations completed during the reporting period, including whether all completed evaluations have been published on a publically available Internet website and whether any completed evaluations did not adhere to the common evaluation standards of practice published under [paragraph (4)](#f-4).
  - (4) **Common evaluation standards—** Not later than February 1, 2014, the Global [AIDS](#h-1) Coordinator shall publish on a publically available Internet website the common evaluation standards of practice referred to in [paragraph (3)(R)](#f-3-R).
  - (5) **Partner country defined—** In this subsection, the term “partner country” means a country with a minimum [United States](/usc/22/1395.md?p=a-1) Government investment of [HIV/AIDS](#h-3) assistance of at least $5,000,000 in the prior fiscal year.
- (g) **Funding limitation—** Of the [funds](/usc/22/2431a.md?p=9) made available to carry out this section in any fiscal year, not more than 7 percent may be used for the administrative expenses of the [United States](/usc/22/1395.md?p=a-1) Agency for International Development in support of activities described in [section 2151b(c) of this title](/usc/22/2151b.md?p=c), this section, [section 2151b–3 of this title](/usc/22/2151b–3.md), and [section 2151b–4 of this title](/usc/22/2151b–4.md). Such amount shall be in addition to other amounts otherwise available for such purposes.
- (h) **Definitions—** In this section:
  - (1) **AIDS—** The term “AIDS” means acquired immune deficiency syndrome.
  - (2) **HIV—** The term “HIV” means the human immunodeficiency virus, the pathogen that causes [AIDS](#h-1).
  - (3) **HIV/AIDS—** The term “HIV/AIDS” means, with respect to an individual, an individual who is infected with [HIV](#h-2) or living with [AIDS](#h-1).
  - (4) **Relevant executive branch agencies—** The term “relevant executive branch agencies” means the Department of State, the [United States](/usc/22/1395.md?p=a-1) Agency for International Development, the Department of Health and Human Services (including its agencies and [offices](/usc/22/2214a.md?p=9)), and any other department or agency of the [United States](/usc/22/1395.md?p=a-1) that participates in international [HIV/AIDS](#h-3) activities pursuant to the authorities of such department or agency or this chapter.

# §2151b–3. Assistance to combat tuberculosis

- (a) **Findings—** Congress makes the following findings:
  - (1) Congress recognizes the growing international problem of tuberculosis and the impact its continued existence has on those countries that had previously largely controlled the disease.
  - (2) Congress further recognizes that the means exist to control and treat tuberculosis through expanded use of the [DOTS](#h-1) ([Directly Observed Treatment Short-course](#h-1)) treatment strategy, including [DOTS-Plus](#h-2) to address multi-drug resistant tuberculosis, and adequate investment in newly created mechanisms to increase access to treatment, including the Global Tuberculosis Drug [Facility](/usc/22/2431a.md?p=8) established in 2001 pursuant to the Amsterdam Declaration to Stop TB and the Global Alliance for TB Drug Development.
- (b) **Policy—** It is a major objective of the [foreign assistance](/usc/22/2394.md?p=b-1) [program](/usc/22/3383.md?p=6) of the [United States](/usc/22/1395.md?p=a-1) to control tuberculosis. In all countries in which the Government of the [United States](/usc/22/1395.md?p=a-1) has established development [programs](/usc/22/3383.md?p=6), particularly in countries with the highest burden of tuberculosis and other countries with high rates of tuberculosis, the [United States](/usc/22/1395.md?p=a-1) should support the objectives of the Global Plan to Stop TB, including through achievement of the following goals:
  - (1) Reduce by half the tuberculosis death and disease burden from the 1990 baseline.
  - (2) Sustain or exceed the detection of at least 70 percent of sputum smear-positive cases of tuberculosis and the successful treatment of at least 85 percent of the cases detected in countries with established [United States](/usc/22/1395.md?p=a-1) Agency for International Development tuberculosis [programs](/usc/22/3383.md?p=6).
  - (3) In support of the Global Plan to Stop TB, the President shall establish a comprehensive, 5-year [United States](/usc/22/1395.md?p=a-1) strategy to expand and improve [United States](/usc/22/1395.md?p=a-1) efforts to combat tuberculosis globally, including a plan to support—
    - (A) the successful treatment of 4,500,000 new sputum smear tuberculosis patients under [DOTS](#h-1) [programs](/usc/22/3383.md?p=6) by 2013, primarily through direct support for needed services, [commodities](/usc/22/2403.md?p=c), health workers, and [training](/usc/22/8921.md?p=3), and additional treatment through coordinated multilateral efforts; and
    - (B) the diagnosis and treatment of 90,000 new multiple drug resistant tuberculosis cases by 2013, and additional treatment through coordinated multilateral efforts.
- (c) **Authorization—** To carry out this section and consistent with [section 2151b(c) of this title](/usc/22/2151b.md?p=c), the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and elimination of tuberculosis.
- (d) **Coordination—** In carrying out this section, the President shall coordinate with the World Health Organization, the Global [Fund](/usc/22/2431a.md?p=9) to Fight [AIDS](/usc/22/2152f.md?p=b-1), Tuberculosis, and Malaria, and other organizations with respect to the development and implementation of a comprehensive tuberculosis control [program](/usc/22/3383.md?p=6).
- (e) **Priority to Stop TB Strategy—** In furnishing assistance under [subsection (c)](#c), the President shall give priority to—
  - (1) direct services described in the [Stop TB Strategy](#h-5), including expansion and enhancement of [Directly Observed Treatment Short-course](#h-1) ([DOTS](#h-1)) coverage, rapid testing, treatment for individuals infected with both tuberculosis and HIV, and treatment for individuals with multi-drug resistant tuberculosis (MDR–TB), strengthening of health systems, use of the International Standards for Tuberculosis Care by all providers, empowering individuals with tuberculosis, and enabling and promoting research to develop new diagnostics, drugs, and vaccines, and [program](/usc/22/3383.md?p=6)-based operational research relating to tuberculosis; and
  - (2) funding for the Global Tuberculosis Drug [Facility](/usc/22/2431a.md?p=8), the [Stop Tuberculosis Partnership](#h-6), and the Global Alliance for TB Drug Development.
- (f) **Assistance for the World Health Organization and the Stop Tuberculosis Partnership—** In carrying out this section, the President, acting through the [Administrator](/usc/22/277d–43.md?p=1) of the [United States](/usc/22/1395.md?p=a-1) Agency for International Development, is authorized to provide increased resources to the World Health Organization and the [Stop Tuberculosis Partnership](#h-6) to improve the capacity of countries with high rates of tuberculosis and other affected countries to implement the [Stop TB Strategy](#h-5) and specific strategies related to addressing multiple drug resistant tuberculosis (MDR–TB) and extensively drug resistant tuberculosis (XDR–TB).
- (g) **Annual report—** The President shall submit an [annual report](/usc/22/6402.md?p=2) to Congress that describes the impact of [United States](/usc/22/1395.md?p=a-1) [foreign assistance](/usc/22/2394.md?p=b-1) on efforts to control tuberculosis, including—
  - (1) the number of tuberculosis cases diagnosed and the number of cases cured in countries receiving [United States](/usc/22/1395.md?p=a-1) bilateral [foreign assistance](/usc/22/2394.md?p=b-1) for tuberculosis control purposes;
  - (2) a description of activities supported with [United States](/usc/22/1395.md?p=a-1) tuberculosis resources in each country, including a description of how those activities specifically contribute to increasing the number of people diagnosed and treated for tuberculosis;
  - (3) in each country receiving bilateral [United States](/usc/22/1395.md?p=a-1) [foreign assistance](/usc/22/2394.md?p=b-1) for tuberculosis control purposes, the percentage provided for direct tuberculosis services in countries receiving [United States](/usc/22/1395.md?p=a-1) bilateral [foreign assistance](/usc/22/2394.md?p=b-1) for tuberculosis control purposes;
  - (4) a description of research efforts and clinical trials to develop new tools to combat tuberculosis, including diagnostics, drugs, and vaccines supported by [United States](/usc/22/1395.md?p=a-1) bilateral assistance;
  - (5) the number of persons who have been diagnosed and started treatment for multidrug-resistant tuberculosis in countries receiving [United States](/usc/22/1395.md?p=a-1) bilateral [foreign assistance](/usc/22/2394.md?p=b-1) for tuberculosis control [programs](/usc/22/3383.md?p=6);
  - (6) a description of the collaboration and coordination of [United States](/usc/22/1395.md?p=a-1) anti-tuberculosis efforts with the World Health Organization, the Global [Fund](/usc/22/2431a.md?p=9), and other major public and private entities within the [Stop TB Strategy](#h-5);
  - (7) the constraints on implementation of [programs](/usc/22/3383.md?p=6) posed by health workforce shortages and capacities;
  - (8) the number of people trained in tuberculosis control; and
  - (9) a breakdown of expenditures for direct patient tuberculosis services, drugs and other [commodities](/usc/22/2403.md?p=c), drug management, [training](/usc/22/8921.md?p=3) in diagnosis and treatment, health systems strengthening, research, and support costs.
- (h) **Definitions—** In this section:
  - (1) **DOTS—** The term “DOTS” or “Directly Observed Treatment Short-course” means the World Health Organization-recommended strategy for treating tuberculosis including—
    - (A) low-cost and effective diagnosis, treatment, and monitoring of tuberculosis;
    - (B) a reliable drug supply;
    - (C) a management strategy for public health systems;
    - (D) health system strengthening;
    - (E) promotion of the use of the International Standards for Tuberculosis Care by all care providers;
    - (F) bacteriology under an external quality assessment framework;
    - (G) short-course chemotherapy; and
    - (H) sound reporting and recording systems.
  - (2) **DOTS-Plus—** The term “DOTS-Plus” means a comprehensive tuberculosis management strategy that is built upon and works as a supplement to the standard [DOTS](#h-1) strategy, and which takes into account specific issues (such as use of second line anti-tuberculosis drugs) that need to be addressed in areas where there is high prevalence of multi-drug resistant tuberculosis.
  - (3) **Global Alliance for Tuberculosis Drug Development—** The term “Global Alliance for Tuberculosis Drug Development” means the public-private partnership that brings together leaders in health, science, philanthropy, and private industry to devise new approaches to tuberculosis and to ensure that new medications are available and affordable in high tuberculosis burden countries and other affected countries.
  - (4) **Global Tuberculosis Drug Facility—** The term “Global Tuberculosis Drug Facility (GDF)” means the new initiative of the [Stop Tuberculosis Partnership](#h-6) to increase access to high-quality tuberculosis drugs to facilitate [DOTS](#h-1) expansion.
  - (5) **Stop TB Strategy—** The term “Stop TB Strategy” means the 6-point strategy to reduce tuberculosis developed by the World Health Organization, which is described in the Global Plan to Stop TB 2006–2015: Actions for Life, a comprehensive plan developed by the Stop TB Partnership that sets out the actions necessary to achieve the millennium development goal of cutting tuberculosis deaths and disease burden in half by 2015.
  - (6) **Stop Tuberculosis Partnership—** The term “Stop Tuberculosis Partnership” means the partnership of the World Health Organization, donors including the [United States](/usc/22/1395.md?p=a-1), high tuberculosis burden countries, multilateral agencies, and nongovernmental and technical agencies committed to short- and long-term measures required to control and eventually eliminate tuberculosis as a public health problem in the world.

# §2151b–4. Assistance to combat malaria

- (a) **Finding—** Congress finds that malaria kills more people annually than any other communicable disease except tuberculosis, that more than 90 percent of all malaria cases are in sub-Saharan Africa, and that children and women are particularly at risk. Congress recognizes that there are cost-effective tools to decrease the spread of malaria and that malaria is a curable disease if promptly diagnosed and adequately treated.
- (b) **Policy—** It is a major objective of the [foreign assistance](/usc/22/2394.md?p=b-1) [program](/usc/22/3383.md?p=6) of the [United States](/usc/22/1395.md?p=a-1) to provide assistance for the prevention, control, treatment, and cure of malaria.
- (c) **Authorization—** To carry out this section and consistent with [section 2151b(c) of this title](/usc/22/2151b.md?p=c), the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and elimination of malaria.
- (d) **Coordination—** In carrying out this section, the President shall coordinate with the World Health Organization, the Global [Fund](/usc/22/2431a.md?p=9) to Fight [AIDS](/usc/22/2152f.md?p=b-1), Tuberculosis, and Malaria, the Department of Health and Human Services (the Centers for Disease Control and Prevention and the National Institutes of Health), and other organizations with respect to the development and implementation of a comprehensive malaria control [program](/usc/22/3383.md?p=6).