HR 5237
110th CONGRESS
2d Session
H. R. 5237
To amend the U.S. Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003.
IN THE HOUSE OF REPRESENTATIVES
February 6, 2008
Mr. MCDERMOTT (for himself and Ms. GRANGER) introduced the following
bill; which was referred to the Committee on Foreign Affairs
A BILL
To amend the U.S. Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Global Pediatric HIV/AIDS Prevention and
Treatment Act'.
SEC. 2. FINDINGS.
Section 2 of the United States Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 (26 U.S.C. 7601) is amended--
(1) in paragraph (3), by adding at the end the following:
`(D) In 2007, the rate at which children accessed treatment failed to
keep pace with new pediatric infections. While children account for
almost 16 percent of all new HIV infections, they make up only 9 percent
of those receiving treatment under this Act.';
(2) by amending paragraph (16) to read as follows:
`(16) Basic interventions to prevent new HIV infections and to bring
care and treatment to people living with AIDS, such as voluntary counseling
and testing, are achieving meaningful results and are cost-effective.
The challenge is to expand these interventions to a national basis in
a coherent and sustainable manner.'; and
(3) by amending paragraph (20) to read as follows:
`(20) With no medical intervention, mothers infected with HIV have a
25 to 30 percent chance of passing the virus to their babies during
pregnancy and childbirth. A simple and effective intervention can significantly
reduce mother to child transmission of HIV. A single dose of an anti-retroviral
drug given once to the mother at the onset of labor, and once to the
baby during the first 3 days of life reduces transmission by approximately
50 percent. Other more complex drug regimens can further reduce transmission
from mother-to-child. A dramatic expansion of access to prevention of
mother-to-child transmission services is critical to preventing thousands
of new pediatric HIV infections.'.
SEC. 3. POLICY PLANNING AND COORDINATION.
Section 101(b)(3) of the United States Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 (22 U.S.C. 7611(b)(3)) is amended by adding at
the end the following:
`(X) A description of the activities that will be conducted to achieve
the targets described in paragraphs (1) and (2) of section 312(b).'.
SEC. 4. BILATERAL EFFORTS.
(a) Assistance To Combat HIV/AIDS- Section 104A of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-2) is amended--
(1) in subsection (d)(1)--
(A) by amending subparagraph (E) to read as follows:
`(i) achieve the target described in section 312(b)(1) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act
of 2003; and
`(ii) promote infant feeding options for HIV positive mothers that
are consistent with the most recent infant feeding recommendations
and guidelines supported by the World Health Organization;';
(B) in subparagraph (G), by striking `and' at the end;
(C) in subparagraph (H), by striking the period at the end and inserting
`; and'; and
(D) by adding at the end the following:
`(I) assistance to achieve the target described in section 312(b)(2)
of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003.'; and
(2) in subsection (e)(2)(C)--
(A) in clause (iii), by striking `and' at the end;
(B) in clause (iv), by striking the period at the end and inserting
`; and'; and
(C) by adding at the end the following:
`(v) the number of HIV-infected children currently receiving antiretroviral
medications in each country under the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003.'.
(b) Assistance to Children and Families- Subtitle B of Title III of the
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act
of 2003 (22 U.S.C. 7651 et seq.) is amended by striking sections 311 and
312 and inserting the following:
`SEC. 311. FINDINGS.
`Congress makes the following findings:
`(1) Every day, approximately 1,100 children around the world are infected
with HIV, the vast majority through mother-to-child transmission during
pregnancy, labor or delivery or soon after through breast-feeding. Approximately
90 percent of these infections occur in Africa.
`(2) With no medical intervention, mothers infected with HIV have a
25 to 30 percent chance of passing the virus to their babies during
pregnancy and childbirth. A single dose of an anti-retroviral drug given
once to the mother at the onset of labor, and once to the baby during
the first 3 days of life reduces transmission by approximately 50 percent.
`(3) Providing the full range of interventions, as is the standard of
care in the United States, could reduce the rate of mother-to-child
transmission of HIV to as little as 2 percent.
`(4) Global coverage of services to prevent transmission from mother-to-child
remains unacceptably low. The Joint United Nations Program on HIV/AIDS
(UNAIDS) reports that fewer than 10 percent of pregnant women with HIV
in resource-poor countries have access to prevention of mother-to-child
transmission services.
`(5) Prevention of mother-to-child transmission programs provide health
benefits for women and children beyond preventing the vertical transmission
of HIV. They serve as an entry point for mothers to access treatment
for their own HIV infection, allowing them to stay healthy and to care
for their children. Efforts to connect and integrate prevention of mother-to-child
transmission and HIV care, treatment and prevention programs are crucial
to achieving improved outcomes for HIV-affected and HIV-infected women
and families.
`(6) Access to comprehensive HIV prevention services must be drastically
scaled-up among pregnant women infected with HIV and pregnant women
not infected with HIV to further protect themselves and their partners
against the sexual transmission of HIV/AIDS.
`(7) Preventing unintended pregnancy among HIV-infected women is recognized
by the World Health Organization and the Office of the United States
Global AIDS Coordinator to be an integral component of prevention of
mother-to-child transmission programs. To further reduce infection rates,
women accessing prevention of mother-to-child transmission services
must have access to a range of high-quality family planning and reproductive
health care, so they can make informed decisions about future pregnancies
and contraception.
`(8) In 2007, the rate at which children were accessing treatment failed
to keep pace with new pediatric infections. While children account for
almost 16 percent of all new HIV infections, they make up only 9 percent
of those on treatment under this Act.
`(9) Of the more than 2,500,000 people who were newly infected with
HIV in 2007, more than 420,000 were children.
`(10) Without proper care and treatment, half of newly HIV-infected
children will die before they reach 2 years of age, and 75 percent will
die before 5 years of age.
`(11) Because children are not just small adults, providing HIV care
and treatment presents special challenges, including--
`(A) limited access to reliable HIV testing for the youngest children;
`(B) a shortage of providers trained in delivering pediatric care;
`(C) weak linkages between services to prevent mother-to-child transmission
and care and treatment programs; and
`(D) the need for low-cost pediatric formulations of HIV/AIDS medications.
`SEC. 312. POLICY AND REQUIREMENTS.
`(1) IN GENERAL- The United States Government's response to the global
HIV/AIDS pandemic should place high priority on--
`(A) the prevention of mother-to-child transmission of HIV/AIDS; and
`(B) the care and treatment of all children affected by HIV/AIDS,
including children orphaned by AIDS.
`(2) COLLABORATION- The United States Government should work in collaboration
with foreign governments, donors, the private sector, nongovernmental
organizations, and other key stakeholders.
`(b) Requirements- The comprehensive, 5-year, global strategy required
under section 101 shall--
`(1) establish a target for prevention of mother-to-child transmission
efforts that by 2013, in those countries most affected by HIV--
`(A) 80 percent of pregnant women receive HIV counseling and testing;
and
`(B) all of the pregnant women receiving HIV counseling and testing
who test positive for HIV receive anti-retroviral medications for
prevention of mother-to-child transmission of HIV;
`(2) establish a target requiring that by 2013, children account for
at least 15 percent of those receiving treatment under this Act;
`(3) integrate prevention, care, and treatment with prevention of mother-to-child
transmission programs, as soon as feasible and consistent with the national
government policies of the foreign countries in which programs under
this Act are administered, to improve outcomes for HIV-affected women
and families and to promote follow-up and continuity of care;
`(4) expand programs designed to care for children orphaned by AIDS;
and
`(5) develop a time line for expanding access to more effective mother-to-child
transmission prevention regimens, consistent with the national government
policies of the foreign countries in which programs under this Act are
administered and the goal of moving towards universal use of such regimens
as rapidly as possible.
`(c) Application of Requirements- All strategic planning documents and
bilateral funding agreements developed under the authority of the Office
of the United States Global AIDS Coordinator, including country operating
plans and any subsequent mechanisms through which funding under this Act
is obligated, shall be consistent with, and in furtherance of, the requirements
under subsection (b).
`(d) Prevention of Mother-to-Child Transmission Expert Panel-
`(1) ESTABLISHMENT- The Coordinator of United States Government Activities
to Combat HIV/AIDS Globally (referred to in this section as the `Coordinator')
shall establish a panel of experts to be known as the Prevention of
Mother to Child Transmission Panel (referred to in this section as the
`Panel') to--
`(A) provide an objective review of activities to prevent mother-to-child
transmission of HIV that receive financial assistance under this Act;
and
`(B) provide recommendations to the Coordinator and to the appropriate
committees of Congress for scale-up of mother-to-child transmission
prevention services under this Act in order to achieve the target
established in subsection (b)(1).
`(2) MEMBERSHIP- The Panel shall be convened and chaired by the Coordinator,
who shall serve as a nonvoting member. The Panel shall consist of not
more than 15 members (excluding the Coordinator), to be appointed by
the Coordinator not later than 60 days after the date of the enactment
of this Act, including--
`(A) 2 members from the Department of Health and Human Services with
expertise relating to the prevention of mother-to-child transmission
activities;
`(B) 2 members from the United States Agency for International Development
with expertise relating to the prevention of mother-to-child transmission
activities;
`(C) 2 representatives from among health ministers of national governments
of foreign countries in which programs under this Act are administered;
`(D) 3 members representing organizations implementing prevention
of mother-to-child transmission activities under this Act;
`(E) 2 health care researchers with expertise relating to global HIV/AIDS
activities; and
`(F) representatives from among patient advocate groups, health care
professionals, persons living with HIV/AIDS, and non-governmental
organizations with expertise relating to the prevention of mother-to-child
transmission activities, giving priority to individuals in foreign
countries in which programs under this Act are administered.
`(3) DUTIES OF PANEL- The Panel shall--
`(A) review activities receiving financial assistance under this Act
to prevent mother-to-child transmission of HIV and assess the effectiveness
of current activities in reaching the target described in subsection
(b)(1);
`(B) review scientific evidence related to the provision of mother-to-child
transmission prevention services, including programmatic data and
data from clinical trials;
`(C) review and assess ways in which the Office of the United States
Global AIDS Coordinator and programs funded under this Act collaborate
with international and multilateral entities on efforts to prevent
mother-to-child transmission of HIV in affected countries;
`(D) identify barriers and challenges to increasing access to mother-to-child
transmission prevention services and evaluate potential mechanisms
to alleviate those barriers and challenges;
`(E) identify the extent to which stigma has hindered pregnant women
from obtaining HIV counseling and testing or returning for results,
and provide recommendations to address such stigma and its effects;
`(F) identify opportunities to improve linkages between mother-to-child
transmission prevention services and care and treatment programs;
`(G) evaluate the adequacy of financial assistance provided under
this Act for mother-to-child transmission of HIV prevention services;
and
`(H) recommend levels of financial assistance and specific activities
to facilitate reaching the target described in subsection (b)(1).
`(A) IN GENERAL- Not later than 14 months after the date of the enactment
of this Act, the Panel shall submit a report containing a detailed
statement of the recommendations, findings, and conclusions of the
Panel to the appropriate congressional committees.
`(B) AVAILABILITY- The report submitted under subparagraph (A) shall
be made available to the public.
`(C) CONSIDERATION BY COORDINATOR- The Coordinator shall--
`(i) consider any recommendations contained in the report submitted
under subparagraph (A); and
`(ii) include in the annual report required under section 104A(e)
of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)) a description
of the activities conducted in response to the recommendations made
by the Panel and an explanation of any recommendations not implemented
at the time of the report.
`(5) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
to the Panel such sums as may be necessary for each of the fiscal years
2009 through 2011 to carry out this section.
`(6) TERMINATION- The Panel shall terminate on the date that is 60 days
after the date on which the Panel submits the report to Congress under
paragraph (4).'.
(c) Annual Report Elements- Section 313(b)(2) of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(b)(2))
is amended--
(1) in subparagraph (C), by striking `and' at the end;
(2) in subparagraph (D), by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following:
`(E) coordination and collaboration with governments, donors, the
private sector, nongovernmental organizations, and other key stakeholders
to achieve the target described in section 312(b)(1); and
`(F) the number of women offered and receiving the 4 components of
a comprehensive strategy to prevent mother-to-child transmission of
HIV, as recommended by the World Health Organization.'.
END
