	Introduction

On May 30, 2007, President Bush announced that he would request $30 billion for the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR), which is the coordinated U.S. government effort to combat HIV/AIDS globally. The President estimated PEPFAR would support treatments for 2.5 million people infected with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the prevention of more than 12 million new HIV infections, and care for more than 12 million HIV-affected people, including 5 million orphans and vulnerable children. In 2003, Congress authorized $15 billion for U.S. efforts to combat global HIV/AIDS, tuberculosis, and malaria from FY2004 through FY2008 with the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 ( P.L. On July 24, 2008, Congress authorized $48 billion for U.S. global efforts to fight HIV/AIDS, tuberculosis, and malaria and for U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) from FY2009 through FY2013 through H.R. 5501 , the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act). 110-293 ) was signed into law on July 30, 2008. It details actual and requested funding for U.S. bilateral and multilateral efforts to fight HIV/AIDS, tuberculosis, and malaria globally through FY2009. The report discusses key policy debates surrounding international HIV/AIDS, malaria, and tuberculosis programs and funding as the 110 th Congress considered legislation to reauthorize PEPFAR programs. It describes the differences, similarities, and possible policy implementation implications of key proposals included in H.R. Finally, this report details key changes to programs and funding for U.S. international efforts to fight HIV/AIDS, tuberculosis, and malaria programs as directed by the 110 th Congress in the Lantos-Hyde Act as enacted. It required that from FY2006 through FY2008 at least 33% of these prevention funds must be spent on abstinence-until-marriage programs. OGAC calculates PEPFAR funding as the total of enacted funding for U.S. efforts to combat HIV/AIDS globally, U.S. efforts to combat tuberculosis internationally, and U.S. contributions to the Global Fund. Key Reauthorization Proposals and Debates

On May 30, 2007, President Bush urged Congress to extend PEPFAR from FY2009 through FY2013 with a $30 billion authorization. Funding Authorization Increase

H.R. Global Malaria Coordinator) at USAID. 5501 proposed adding Vietnam as a Focus Country as well as those countries listed in H.R. 108-25 , the Leadership Act. 5501 also proposed requiring the U.S. strategy to combat global AIDS to "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." 5501 as passed by the Senate proposed eliminating the language in the Immigration and Nationality Act (INA) that statutorily bars foreign nationals with HIV/AIDS from entering the United States. The Lantos-Hyde Act authorizes $48 billion from FY2009 through FY2013 for U.S. efforts to fight HIV/AIDS, TB, and malaria globally ( Table 4 ) . The Lantos-Hyde Act also directs a number of key changes to U.S. global HIV/AIDS, tuberculosis, and malaria programs ( Table 5 ) .
The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25) authorized $15 billion for U.S. global efforts to combat HIV/AIDS, tuberculosis (TB), and malaria from FY2004 through FY2008. It also authorized the Office of the Global AIDS Coordinator (OGAC) to oversee U.S. government efforts to combat HIV/AIDS internationally. This coordinated U.S. government effort to combat HIV/AIDS globally implements the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year initiative proposed by President Bush in January 2003.
In 2007, President Bush urged Congress to extend PEPFAR for an additional five years by authorizing $30 billion from FY2009 through FY2013. The Administration estimated $30 billion would support HIV/AIDS treatments for 2.5 million people, prevent more than 12 million new HIV infections, and care for more than 12 million HIV-affected people, including 5 million orphans and vulnerable children.
On July 24, 2008, the 110th Congress authorized $48 billion for U.S. international HIV/AIDS, tuberculosis, and malaria programs from FY2009 through FY2013 by passing H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act). On July 30, 2008, H.R. 5501 was enacted into law as P.L. 110-293.
The Lantos-Hyde Act made a number of changes to U.S. international HIV/AIDS, tuberculosis, and malaria programs. It authorized increased funding for U.S. efforts to fight HIV/AIDS, tuberculosis, and malaria and for U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). It added Vietnam to the list of PEPFAR Focus Countries; authorized the use of compacts or framework agreements between the United States and countries already receiving U.S. funds to fight HIV/AIDS; and removed the 33% spending requirement on abstinence-until-marriage programs within HIV/AIDS prevention efforts, as well as the 20% spending recommendation on prevention efforts overall. It authorized a U.S. Global Malaria Coordinator within the U.S. Agency for International Development (USAID) and emphasized strategies to promote the sustainability of health care systems in affected countries. It eliminated Immigration and Nationality Act (INA) language that statutorily barred foreign nationals with HIV/AIDS from entering the United States.
This report provides background on PEPFAR implementation and results. It details actual and requested funding for U.S. bilateral and multilateral efforts to fight HIV/AIDS, tuberculosis, and malaria globally through FY2009. It discusses key policy debates surrounding international HIV/AIDS, malaria, and tuberculosis programs and funding as the 110th Congress considered legislation to reauthorize PEPFAR programs. It describes key proposals included in H.R. 5501 at two points during its consideration by the 110th Congress and the possible policy implementation implications of these proposals. Finally, this report details key changes to programs and funding for U.S. international efforts to fight HIV/AIDS, tuberculosis, and malaria programs as directed by the 110th Congress in the Lantos-Hyde Act as enacted. The policy debates surrounding and program and funding authorizations resulting from the Lantos-Hyde Act may be a prelude to the work of the 111th Congress, as it considers whether and at what level to fund these activities in FY2009 through FY2011. This report will not be updated.