	Background

In January 2003, President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR), a government-wide initiative to combat global HIV/AIDS. Later that year, Congress enacted the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act), P.L. 108-25 , which authorized $15 billion to be spent from FY2004 to FY2008 on bilateral and multilateral HIV/AIDS, tuberculosis (TB), and malaria programs. The Act included language that instructed how the funds should be spent, listed several goals and targets, and required the President to establish the Coordinator of the United States Government Activities to Combat HIV/AIDS Globally (known as the Global AIDS Coordinator) at the Department of State. The Office of the Global AIDS Coordinator (OGAC) distributes the majority of the funds it receives from Congress for global HIV/AIDS programs to U.S. federal agencies and departments and multilateral groups like the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). In 2008, Congress enacted the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act), P.L. 110-293 , which amended the Leadership Act to authorize the appropriation of $48 billion for global HIV/AIDS, TB, and malaria efforts from FY2009 to FY2013. Key amendments in the Act established the Coordinator of the United States Government Activities to Combat Malaria Globally (known as the Malaria Coordinator) at the U.S. Agency for International Development (USAID). Certain provisions within the Leadership Act, as amended, and the Lantos-Hyde Act are set to expire at the end of FY2013. 3177 ) entitled the PEPFAR Stewardship and Oversight Act. The bills extend authorities related to key priority areas: authorizing appropriations for the Global Fund, expanding reporting requirements, and allocating a portion of global HIV/AIDS funds for orphans and vulnerable children (OVC) and for HIV/AIDS treatment and care. Table A-1 in Appendix A offers a side-by-side comparison of the Leadership Act in its original form and the Lantos-Hyde Act, which amends the Leadership Act and other legislation. A third column explains which sections are set to expire and summarizes language in S. 1545 and H.R. 3177 that amend the Leadership Act, as amended. The Leadership Act, as amended, Lantos-Hyde Act, and legislation that these Acts amend include language to facilitate oversight of U.S. global HIV/AIDS, TB, and malaria programs, as well as to ensure key congressional priorities are met. It does not appear some of the contentious issues that dominated debate when crafting the Leadership and Lantos-Hyde Acts (such as family planning) will be revisited at this time. S. 1545 , the PEPFAR Stewardship and Oversight Act and its House companion ( H.R. The following sections describe which authorities in the Leadership Act, as amended, and the Lantos-Hyde Act are set to expire and which are enduring. Congress amended these reporting requirements through the Lantos-Hyde Act and added some additional ones. The Leadership Act authorized $15 billion for the U.S. fight against HIV/AIDS, TB, and malaria from FY2004 through FY2008; and the Lantos-Hyde Act amended the Leadership Act to authorize $48 billion from FY2009 through FY2013 for the acceleration of U.S. efforts to combat the three diseases. In addition to expiring authorities cited above, language in the Leadership Act, as amended and Lantos-Hyde Act (and the legislation that they amended) set program targets for TB programs, prioritized U.S. efforts to fight TB and malaria worldwide, and established a coordinator of all U.S. global malaria programs. Appendix A. Legislative Tables
The Leadership Act, as amended, Lantos-Hyde Act, and Foreign Assistance Act as amended, include several reporting requirements. Appendix B.
Fighting HIV/AIDS, tuberculosis (TB), and malaria globally is a priority for Congress. The 108th and 110th Congresses enacted two pieces of legislation that have shaped U.S. responses to these diseases: P.L. 108-25, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act), and P.L. 110-293, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act). The Leadership Act authorized $15 billion to be spent from FY2004 through FY2008 on fighting HIV/AIDS, TB, and malaria. The Lantos-Hyde Act amended the Leadership Act to authorize $48 billion for fighting the three diseases from FY2009 through FY2013.
The Leadership Act (and the legislation that it amends) is the primary vehicle through which U.S. global assistance for fighting these diseases is authorized. The Lantos-Hyde Act mostly amends the Leadership Act, though it amends some other acts, such as the Foreign Assistance Act of 1961, and includes some stand-alone authorities. The Leadership Act and the Lantos-Hyde Act (primarily through amendments to the Leadership Act) created frameworks for how the funds should be spent, established program goals and targets, and established coordinating offices for managing government-wide responses.
The Leadership Act required the President to establish the Coordinator of the United States Government Activities to Combat HIV/AIDS Globally (known as the Global AIDS Coordinator) at the Department of State. Congress appropriates the bulk of global HIV/AIDS funds to the Office of the Global AIDS Coordinator, which leads the President's Emergency Plan for AIDS Relief (PEPFAR). The Global AIDS Coordinator distributes the majority of these funds to U.S. federal agencies and departments and multilateral groups like the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Lantos-Hyde Act amended the Leadership Act to establish the Coordinator of the United States Government Activities to Combat Malaria Globally (known as the Malaria Coordinator) at the U.S. Agency for International Development (USAID) to oversee implementation of related efforts by USAID and the Centers for Disease Control and Prevention.
Some authorities within these Acts are enduring, such as those that created the Global AIDS and Malaria Coordinator positions (Leadership Act, as amended) and permitted U.S. participation in advance market commitments for vaccine development (Lantos-Hyde Act). Other authorities, however, are set to expire, such as language authorizing funding for global HIV/AIDS, TB, and malaria programs.
This report explains which authorities within the Leadership and Lantos-Hyde Acts are set to expire and which are permanent. Table A-1 in the Appendix A offers a side-by-side comparison of the Leadership Act in its original form and the Lantos-Hyde Act, which amends the Leadership Act and other legislation. A third column explains which sections are set to expire and summarizes language in S. 1545 and H.R. 3177 that amend the Leadership Act, as amended. The Leadership Act, as amended and Lantos-Hyde Act include comprehensive reporting requirements. Table A-2 in the Appendix A lists the reporting requirements and describes the extent to which the Administration has complied with the requirements.
Rather than revisit some of the contentious issues that dominated debate when crafting the Lantos-Hyde Act, House and Senate Members introduced legislation (H.R. 3177 and S. 1545) that is narrowly aimed at key priorities: enhancing oversight of U.S. global HIV/AIDS, TB, and malaria programs; authorizing appropriations for the Global Fund through FY2018; and allocating a portion of HIV/AIDS funds for orphans and vulnerable children (OVC) and for HIV/AIDS treatment and care. Table B-1 in Appendix B summarizes key amendments in the bills, entitled the PEPFAR Stewardship and Oversight Act.