22 U.S. Code § 7611 - Development of a comprehensive, five-year, global strategy
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The President shall establish a comprehensive, integrated, 5-year strategy to expand and improve efforts to combat global HIV/AIDS. This strategy shall—
(1) further strengthen the capability of the United States to be an effective leader of the international campaign against this disease and strengthen the capacities of nations experiencing HIV/AIDS epidemics to combat this disease;
(2) maintain sufficient flexibility and remain responsive to—
(B) challenges facing partner countries in developing and implementing an effective national response; and
(3) situate United States efforts to combat HIV/AIDS, tuberculosis, and malaria within the broader United States global health and development agenda, establishing a roadmap to link investments in specific disease programs to the broader goals of strengthening health systems and infrastructure and to integrate and coordinate HIV/AIDS, tuberculosis, or malaria programs with other health or development programs, as appropriate;
(4) provide a plan to—
(i) the increase in the number of individuals with HIV/AIDS receiving antiretroviral treatment above the goal established under section 7672 (a)(3) of this title and increased pursuant to paragraphs (1) through (3) of section 7673 (d) of this title; and
(C) support care for 12,000,000 individuals infected with or affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children affected by HIV/AIDS, with an emphasis on promoting a comprehensive, coordinated system of services to be integrated throughout the continuum of care;
(D) help partner countries in the effort to achieve goals of 80 percent access to counseling, testing, and treatment to prevent the transmission of HIV from mother to child, emphasizing a continuum of care model;
(E) help partner countries to provide care and treatment services to children with HIV in proportion to their percentage within the HIV-infected population in each country;
(F) promote preservice training for health professionals designed to strengthen the capacity of institutions to develop and implement policies for training health workers to combat HIV/AIDS, tuberculosis, and malaria;
(G) equip teachers with skills needed for HIV/AIDS prevention and support for persons with, or affected by, HIV/AIDS;
(I) promote pediatric HIV/AIDS training for physicians, nurses, and other health care workers, through public-private partnerships if possible, including through the designation, if appropriate, of centers of excellence for training in pediatric HIV/AIDS prevention, care, and treatment in partner countries; and
(J) help partner countries to train and support retention of health care professionals and paraprofessionals, with the target of training and retaining at least 140,000 new health care professionals and paraprofessionals with an emphasis on training and in country deployment of critically needed doctors and nurses and to strengthen capacities in developing countries, especially in sub-Saharan Africa, to deliver primary health care with the objective of helping countries achieve staffing levels of at least 2.3 doctors, nurses, and midwives per 1,000 population, as called for by the World Health Organization;
(5) include multisectoral approaches and specific strategies to treat individuals infected with HIV/AIDS and to prevent the further transmission of HIV infections, with a particular focus on the needs of families with children (including the prevention of mother-to-child transmission), women, young people, orphans, and vulnerable children;
(6) establish a timetable with annual global treatment targets with country-level benchmarks for antiretroviral treatment;
(7) expand the integration of timely and relevant research within the prevention, care, and treatment of HIV/AIDS;
(8) include a plan for program monitoring, operations research, and impact evaluation and for the dissemination of a best practices report to highlight findings;
(9) support the in-country or intra-regional training, preferably through public-private partnerships, of scientific investigators, managers, and other staff who are capable of promoting the systematic uptake of clinical research findings and other evidence-based interventions into routine practice, with the goal of improving the quality, effectiveness, and local leadership of HIV/AIDS health care;
(10) expand and accelerate research on and development of HIV/AIDS prevention methods for women, including enhancing inter-agency collaboration, staffing, and organizational infrastructure dedicated to microbicide research;
(11) provide for consultation with local leaders and officials to develop prevention strategies and programs that are tailored to the unique needs of each country and community and targeted particularly toward those most at risk of acquiring HIV infection;
(12) make the reduction of HIV/AIDS behavioral risks a priority of all prevention efforts by—
(B) encouraging the correct and consistent use of male and female condoms and increasing the availability of, and access to, these commodities;
(D) promoting education for discordant couples (where an individual is infected with HIV and the other individual is uninfected or whose status is unknown) about safer sex practices;
(E) promoting voluntary counseling and testing, addiction therapy, and other prevention and treatment tools for illicit injection drug users and other substance abusers;
(F) educating men and boys about the risks of procuring sex commercially and about the need to end violent behavior toward women and girls;
(G) supporting partner country and community efforts to identify and address social, economic, or cultural factors, such as migration, urbanization, conflict, gender-based violence, lack of empowerment for women, and transportation patterns, which directly contribute to the transmission of HIV;
(H) supporting comprehensive programs to promote alternative livelihoods, safety, and social reintegration strategies for commercial sex workers and their families;
(I) promoting cooperation with law enforcement to prosecute offenders of trafficking, rape, and sexual assault crimes with the goal of eliminating such crimes; and
(13) include programs to reduce the transmission of HIV, particularly addressing the heightened vulnerabilities of women and girls to HIV in many countries; and
(14) support other important means of preventing or reducing the transmission of HIV, including—
(D) educating the public to recognize and to avoid risks to contract HIV through blood exposures during formal and informal health care and cosmetic services;
(E) investigating suspected nosocomial infections to identify and stop further nosocomial transmission; and
(16) build capacity within the public health sector of developing countries by improving health systems and public health infrastructure and developing indicators to measure changes in broader public health sector capabilities;
(18) provide a framework for expanding or developing existing or new country or regional programs, including—
(19) provide a plan for national and regional priorities for resource distribution and a global investment plan by region;
(20) provide a plan to address the immediate and ongoing needs of women and girls, which—
(C) provides clear guidance to field missions to integrate gender across prevention, care, and treatment programs;
(D) sets forth gender-specific indicators to monitor progress on outcomes and impacts of gender programs;
(E) supports efforts in countries in which women or orphans lack inheritance rights and other fundamental protections to promote the passage, implementation, and enforcement of such laws;
(F) supports life skills training, especially among women and girls, with the goal of reducing vulnerabilities to HIV/AIDS;
(21) provide a plan to—
(A) determine the local factors that may put men and boys at elevated risk of contracting or transmitting HIV;
(22) provide a plan to address the vulnerabilities and needs of orphans and children who are vulnerable to, or affected by, HIV/AIDS;
(23) encourage partner countries to develop health care curricula and promote access to training tailored to individuals receiving services through, or exiting from, existing programs geared to orphans and vulnerable children;
(24) provide a framework to work with international actors and partner countries toward universal access to HIV/AIDS prevention, treatment, and care programs, recognizing that prevention is of particular importance;
(25) enhance the coordination of United States bilateral efforts to combat global HIV/AIDS with other major public and private entities;
(26) enhance the attention given to the national strategic HIV/AIDS plans of countries receiving United States assistance by—
(27) support activities described in the Global Plan to Stop TB, including—
(A) expanding and enhancing the coverage of the Directly Observed Treatment Short-course (DOTS) in order to treat individuals infected with tuberculosis and HIV, including multi-drug resistant or extensively drug resistant tuberculosis; and
(28) ensure coordination between the Global AIDS Coordinator and the Malaria Coordinator and address issues of comorbidity between HIV/AIDS and malaria; and
(1) In general
Not later than October 1, 2009, the President shall submit a report to the appropriate congressional committees that sets forth the strategy described in subsection (a).
The report required under paragraph (1) shall include a discussion of the following elements:
(C) The desired goals, objectives, activities, and outcome-related performance measures of the strategy.
(E) A delineation of United States Government roles, responsibility, and coordination mechanisms of the strategy.
(F) A description of the strategy—
(i) to promote harmonization of United States assistance with that of other international, national, and private actors as elucidated in the “Three Ones”; and
(G) A description of the manner in which the strategy will—
(i) further the development and implementation of the national multisectoral strategic HIV/AIDS frameworks of partner governments; and
(H) A description of how the strategy will seek to achieve the specific targets described in subsection (a) and other targets, as appropriate.
(I) A description of, and rationale for, the timetable for annual global treatment targets with country-level estimates of numbers of persons in need of antiretroviral treatment, country-level benchmarks for United States support for assistance for antiretroviral treatment, and numbers of persons enrolled in antiretroviral treatment programs receiving United States support. If global benchmarks are not achieved within the reporting period, the report shall include a description of steps being taken to ensure that global benchmarks will be achieved and a detailed breakdown and justification of spending priorities in countries in which benchmarks are not being met, including a description of other donor or national support for antiretroviral treatment in the country, if appropriate.
(J) A description of how operations research is addressed in the strategy and how such research can most effectively be integrated into care, treatment, and prevention activities in order to—
(K) An analysis of United States-assisted strategies to prevent the transmission of HIV/AIDS, including methodologies to promote abstinence, monogamy, faithfulness, the correct and consistent use of male and female condoms, reductions in concurrent sexual partners, and delay of sexual debut, and of intended monitoring and evaluation approaches to measure the effectiveness of prevention programs and ensure that they are targeted to appropriate audiences.
(L) Within the analysis required under subparagraph (K), an examination of additional planned means of preventing the transmission of HIV including medical male circumcision, maintenance of a safe blood supply, public education about risks to acquire HIV infection from blood exposures, promotion of universal precautions, investigation of suspected nosocomial infections and other tools.
(M) A description of efforts to assist partner country and community to identify and address social, economic, or cultural factors, such as migration, urbanization, conflict, gender-based violence, lack of empowerment for women, and transportation patterns, which directly contribute to the transmission of HIV.
(N) A description of the specific targets, goals, and strategies developed to address the needs and vulnerabilities of women and girls to HIV/AIDS, including—
(ii) activities to enhance educational, microfinance, and livelihood opportunities for women and girls;
(iii) activities to promote and protect the legal empowerment of women, girls, and orphans and vulnerable children;
(O) A description of strategies to address male norms and behaviors that contribute to the transmission of HIV, to promote responsible male behavior, and to promote male participation and leadership in HIV/AIDS prevention, care, treatment, and voluntary counseling and testing.
(P) A description of strategies—
(i) to address the needs of orphans and vulnerable children, including an analysis of—
(Q) A description of capacity-building efforts undertaken by countries themselves, including adherents of the Abuja Declaration and an assessment of the impact of International Monetary Fund macroeconomic and fiscal policies on national and donor investments in health.
(R) A description of the strategy to—
(v) promote the use of codes of conduct for ethical recruiting practices for health care workers; and
(S) A description of the criteria for selection, objectives, methodology, and structure of compacts or other framework agreements with countries or regional organizations, including—
(T) A strategy to better coordinate HIV/AIDS assistance with nutrition and food assistance programs.
(U) A description of transnational or regional initiatives to combat regionalized epidemics in highly affected areas such as the Caribbean.
(W) A description of coordination efforts in order to better implement the Stop TB Strategy and to address the problem of coinfection of HIV/AIDS and tuberculosis and of projected challenges or barriers to successful implementation.
(c) Study of progress toward achievement of policy objectives
(1) Design and budget plan for data evaluation
The Global AIDS Coordinator shall enter into a contract with the Institute of Medicine of the National Academies that provides that not later than 18 months after July 30, 2008, the Institute, in consultation with the Global AIDS Coordinator and other relevant parties representing the public and private sector, shall provide the Global AIDS Coordinator with a design plan and budget for the evaluation and collection of baseline and subsequent data to address the elements set forth in paragraph (2)(B). The Global AIDS Coordinator shall submit the budget and design plan to the appropriate congressional committees.
(A) In general
Not later than 4 years after July 30, 2008, the Institute of Medicine of the National Academies shall publish a study that includes—
The study conducted under this paragraph shall include—
(ii) an assessment of the effects on health systems, including on the financing and management of health systems and the quality of service delivery and staffing;
(iii) an assessment of efforts to address gender-specific aspects of HIV/AIDS, including gender related constraints to accessing services and addressing underlying social and economic vulnerabilities of women and men;
(iv) an evaluation of the impact of treatment and care programs on 5-year survival rates, drug adherence, and the emergence of drug resistance;
(v) an evaluation of the impact of prevention programs on HIV incidence in relevant population groups;
(vi) an evaluation of the impact on child health and welfare of interventions authorized under this chapter on behalf of orphans and vulnerable children;
(vii) an evaluation of the impact of programs and activities authorized in this chapter on child mortality; and
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).
(d) Comptroller General report
(1) Report required
Not later than 3 years after July 30, 2008, the Comptroller General of the United States shall submit a report on the global HIV/AIDS programs of the United States to the appropriate congressional committees.
The report required under paragraph (1) shall include—
(A) a description and assessment of the monitoring and evaluation practices and policies in place for these programs;
(B) an assessment of coordination within Federal agencies involved in these programs, examining both internal coordination within these programs and integration with the larger global health and development agenda of the United States;
(D) an assessment of harmonization with national government HIV/AIDS and public health strategies as well as other international efforts;
(E) an assessment of the impact of global HIV/AIDS funding and programs on other United States global health programming; and
(e) Best practices report
(1) In general
Not later than 1 year after July 30, 2008, and annually thereafter, the Global AIDS Coordinator shall publish a best practices report that highlights the programs receiving financial assistance from the United States that have the potential for replication or adaption, particularly at a low cost, across global AIDS programs, including those that focus on both generalized and localized epidemics.
(2) Dissemination of findings
(A) Publication on Internet website
The Global AIDS Coordinator shall disseminate the full findings of the annual best practices report on the Internet website of the Office of the Global AIDS Coordinator.
(f) Inspectors General
(1) Oversight plan
The Inspectors General of the Department of State and Broadcasting Board of Governors, the Department of Health and Human Services, and the United States Agency for International Development shall jointly develop coordinated annual plans for oversight activity in each of the fiscal years 2009 through 2018, with regard to the programs authorized under this chapter and sections 2151b–2, 2151b–3, and 2151b–4 of this title.
The plans developed under subparagraph (A) shall include a schedule for financial audits, inspections, and performance reviews, as appropriate.
(i) Initial plan The first plan developed under subparagraph (A) shall be completed not later than the later of—
(ii) 2010 through 2013 plans Each of the plans for fiscal years 2010 through 2013 developed under subparagraph (A) shall be completed not later than 30 days before each of the fiscal years 2010 through 2013, respectively.
(iii) 2014 plan The plan developed under subparagraph (A) for fiscal year 2014 shall be completed not later than 60 days after December 2, 2013.
In order to avoid duplication and maximize efficiency, the Inspectors General described in paragraph (1) shall coordinate their activities with—
(B) the Inspectors General of the Department of Commerce, the Department of Defense, the Department of Labor, and the Peace Corps, as appropriate, pursuant to the 2004 Memorandum of Agreement Coordinating Audit Coverage of Programs and Activities Implementing the President’s Emergency Plan for AIDS Relief, or any successor agreement.
The Global AIDS Coordinator and the Coordinator of the United States Government Activities to Combat Malaria Globally shall make available necessary funds not exceeding $15,000,000 during the 5-year period beginning on October 1, 2008 to the Inspectors General described in paragraph (1) for the audits, inspections, and reviews described in that paragraph.
(g) Annual study
(1) In general
Not later than September 30, 2009, and annually thereafter through September 30, 2019, the Global AIDS Coordinator shall complete a study of treatment providers that—
(B) estimates the per-patient cost of antiretroviral HIV/AIDS treatment and the care of people with HIV/AIDS not receiving antiretroviral treatment, including a comparison of the costs for equivalent services provided by programs not receiving assistance under this chapter;
(2) 2013 through 2018 studies
The studies required to be submitted by September 30, 2014, and annually thereafter through September 30, 2018, shall include, in addition to the elements set forth under paragraph (1), the following elements:
(A) A plan for conducting cost studies of United States assistance under section 2151b–2 of this title in partner countries, taking into account the goal for more systematic collection of data, as well as the demands of such analysis on available human and fiscal resources.
(B) A comprehensive and harmonized expenditure analysis by partner country, including—
(i) an analysis of Global Fund and national partner spending and comparable data across United States, Global Fund, and national partner spending; or
Not later than 90 days after the completion of each study under paragraph (1), the Global AIDS Coordinator shall make the results of such study available on a publicly accessible Web site.
The Global AIDS Coordinator shall develop a message, to be prominently displayed by each program receiving funds under this chapter, that—
(1) demonstrates that the program is a commitment by citizens of the United States to the global fight against HIV/AIDS, tuberculosis, and malaria; and
Source(Pub. L. 108–25, title I, § 101,May 27, 2003, 117 Stat. 718; Pub. L. 110–293, title I, § 101,July 30, 2008, 122 Stat. 2923; Pub. L. 113–56, §§ 2, 3,Dec. 2, 2013, 127 Stat. 648.)
References in Text
This chapter, referred to in subsecs. (c)(2)(B)(vi), (vii), (f)(1)(A), (g)(1)(B), and (h), was in the original “this Act”, meaning Pub. L. 108–25, May 27, 2003, 117 Stat. 711, which is classified principally to this chapter. For complete classification of this Act to the Code, see Short Title note set out under section 7601 of this title and Tables.
2013—Subsec. (f)(1)(A). Pub. L. 113–56, § 2(1), substituted “coordinated annual plans for oversight activity in each of the fiscal years 2009 through 2018” for “5 coordinated annual plans for oversight activity in each of the fiscal years 2009 through 2013”.
Subsec. (f)(1)(C)(ii). Pub. L. 113–56, § 2(2)(A), substituted “2010 through 2013 plans” for “Subsequent plans” in heading and “the plans for fiscal years 2010 through 2013” for “the last four plans” in text.
Subsec. (f)(1)(C)(iii), (iv). Pub. L. 113–56, § 2(2)(B), added cls. (iii) and (iv).
Subsec. (g)(1). Pub. L. 113–56, § 3(a)(1), substituted “through September 30, 2019” for “through September 30, 2013” in introductory provisions.
Subsec. (g)(2), (3). Pub. L. 113–56, § 3(a)(2), (3), added par. (2) and redesignated former par. (2) as (3).
Subsec. (g)(4). Pub. L. 113–56, § 3(a)(4), added par. (4).
2008—Subsec. (a). Pub. L. 110–293, § 101(a), amended subsec. (a) generally. Prior to amendment, subsec. (a) required the President to establish a comprehensive, integrated, five-year strategy to combat global HIV/AIDS that strengthened the capacity of the United States to be an effective leader of the international campaign against HIV/AIDS and set out standards in pars. (1) to (10) for this strategy.
Subsec. (b). Pub. L. 110–293, § 101(b), amended subsec. (b) generally. Prior to amendment, subsec. (b) consisted of pars. (1) to (3) relating to presidential submission of a report to Congress setting forth the strategy described in subsec. (a).
Subsec. (c). Pub. L. 110–293, § 101(c), amended subsec. (c) generally. Prior to amendment, subsec. (c) related to the study of success rates and distribution of resources under the strategy described in subsec. (a).
Subsecs. (d) to (f). Pub. L. 110–293, § 101(d), added subsecs. (d) to (f).
Subsecs. (g), (h). Pub. L. 110–293, § 101(e), added subsecs. (g) and (h).
Delegation of Certain Authority Under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
For delegation of functions of President under this chapter to Secretary of State, see Delegation of Functions note set out under section 7601 of this title.
Memorandum for the Secretary of State
By the authority vested in me as President by the Constitution and the laws of the United States, including section 301 of title 3, United States Code, I hereby delegate to you the functions and authority conferred upon the President by sections 202(c), 305, and 313 of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108–25) [22 U.S.C. 7622 (c), 7635, and 7653], to provide the specified reports to the Congress. In addition, I delegate to you the authority vested in the President by section 101 ofPublic Law 108–25 [22 U.S.C. 7611] to establish a comprehensive, integrated, 5-year strategy to combat global HIV/AIDS and to submit to the appropriate congressional committees a report setting forth the strategy.
You are authorized and directed to publish this memorandum in the Federal Register.George W. Bush.
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