	Introduction

Over the past decade, the United States has recognized the human immunodeficiency virus and the acquired immune deficiency syndrome (HIV/AIDS) as a key foreign policy priority. Congressional authorization of the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003 brought unprecedented attention and funding to the epidemic and established a new and central role for donor governments in the fight against HIV/AIDS, particularly regarding the provision of AIDS treatment. Since the beginning of the epidemic, more than 60 million people have been infected with HIV. In 2010, there were an estimated 34 million people living with the virus. Women make up 50% of all adults living with HIV. Incidence has fallen by more than 25% in 33 countries between 2001 and 2009, including in 22 sub-Saharan African countries. Legislation on Global HIV/AIDS, 2003-2011

On May 27, 2003, President George W. Bush signed into law the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act, P.L. 108-25 ). The Leadership Act authorized $15 billion for global HIV/AIDS, TB, and malaria programs from FY2004 through FY2008. On July 24, 2008, President Bush signed into law the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act, P.L. 110-293 ). As part of the act, Congress removed the recommendations that 20% of funds be spent on prevention efforts and that 33% of these funds be used for abstinence-until-marriage programs, and required the following:
for each fiscal year from FY2009 to FY2013, at least 10% of funds be spent on orphans and vulnerable children; for each fiscal year from FY2009 to FY2013, more than 50% of bilateral assistance be spent on treatment and care of individuals infected with HIV/AIDS; balanced funding for prevention activities including those that promote abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction and country-specific implementation of such activities; and a report to Congress should less than 50% of prevention funds go to activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction in any country with a generalized epidemic. U.S. LIFE sought to address HIV/AIDS in 14 African countries and in India and represented the first time agencies other than the United States Agency for International Development (USAID) were included in the U.S. response to HIV/AIDS. At the time it was established, health experts were debating whether the international community had a responsibility to provide ART to HIV-positive people in developing countries and whether they could be safely administered in such environments. PEPFAR responded to calls from those advocating treatment for the world's poor and demonstrated that ART could be effectively provided in low-resource settings. Through the Leadership Act, Congress authorized the establishment of the Office of the Global AIDS Coordinator (OGAC), at the Department of State. Centers for Diseases Control and Prevention (CDC) : CDC's Global AIDS Program (GAP) operates in 38 countries and four regional programs. U.S. The United States also supports global HIV/AIDS programs through contributions to the Global Fund, an international financing mechanism for the response to HIV/AIDS, TB, and malaria ( Table 2 ). Through authorizing legislation and annual appropriations, Congress provides funds to several multilateral organizations and international research initiatives that contribute to the fight against HIV/AIDS, including the Global Fund and the United Nations Joint Program on HIV/AIDS (UNAIDS). The United States is one of the largest contributors to UNAIDS. Key Issues in Global HIV/AIDS

The 112 th Congress will continue to be faced with a number of issues regarding the U.S. response to global HIV/AIDS, including how much assistance to provide and how to best apportion global HIV/AIDS funds. Global health experts have increasingly debated the sustainability of HIV/AIDS treatment programs and how to use limited resources to both treat those in need while also preventing new infections.
The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the world's most pressing global health challenges. Since the beginning of the epidemic, more than 60 million people have been infected with HIV, approximately 30 million of whom have died of HIV-related causes. At the end of 2010, an estimated 34 million people were living with the virus, the vast majority of whom live in sub-Saharan Africa. Expanded access to antiretroviral therapy (ART) over the past decade, due in large part to U.S. support, has contributed to declines in deaths among people living with HIV. Nonetheless, new infections continue to outpace access to treatment. The second session of the 112th Congress will likely be faced with determining how, and to what extent, the United States should respond to the continued challenge of global HIV/AIDS.
The United States has recognized HIV/AIDS as a key foreign policy priority. Congress has passed several pieces of legislation related to global HIV/AIDS prevention, treatment, and care. In particular, in 2003, Congress enacted the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25), authorizing $15 billion to combat global HIV/AIDS, tuberculosis (TB), and malaria through the President's Emergency Plan for AIDS Relief (PEPFAR), an initiative proposed by the George W. Bush Administration. 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 (P.L. 110-293), authorizing $48 billion for HIV/AIDS, TB, and malaria programs from FY2009 through FY2013.
PEPFAR is the largest commitment in history by any nation to combat a single disease and makes up the majority of donor funding for global HIV/AIDS. When PEPFAR was announced, health experts were debating whether the international community had a responsibility to provide ART in developing countries and whether they could be safely administered in such environments. PEPFAR responded to calls from those advocating treatment for the world's poor and demonstrated that ART could be effectively provided in low-resource settings.
PEPFAR is coordinated by the Office of the U.S. Global AIDS Coordinator (OGAC) at the Department of State and is implemented by a range of U.S. agencies that include, among others, the United States Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC). The United States also supports several multilateral organizations responding to HIV/AIDS, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United Nations Joint Program on HIV/AIDS (UNAIDS).
Due in part to the global response to HIV/AIDS, substantial progress has been made in combating the epidemic. New HIV infections fell by more than 25% in 33 countries between 2001 and 2009, and a total of 2.5 million deaths have been averted in low- and middle-income countries since 1995 due to antiretroviral therapy. At the same time, major challenges remain in the fight against HIV/AIDS. For example, with new infections outpacing available treatment, experts have increasingly debated how to best allocate limited resources. This report outlines basic facts related to global HIV/AIDS, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to global HIV/AIDS. It concludes with a brief description of some of the major issues that might be considered by the 112th Congress in its response to the disease. The report will be updated as events warrant.