,i #aacth ,,congress #ast ,session ,h4 ,r4 #caag ,,in ,,the ,,house ,,of ,,representatives ,september #ag1 #bjac,ms4 ,lee of ,california introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to bring an end to the spread of ,,hiv_/,,aids in the ,united ,states and around the world4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,ending the ,,hiv_/,,aids ,epidemic ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,statement of policy4,sec4 #c4 ,findings4,title ,i--,global ,,hiv_/,,aids-,free ,generation ,strategy,sec4 #aja4 ,global ,,hiv_/,,aids-,free ,generation ,strategy4,title ,,ii--,using funds strategically to maximize results,sec4 #bja4 ,support for operations research to improve program delivery1 efficiency1 impact1 and effectiveness4,sec4 #bjb4 ,increasing coordination and integration of ,,hiv_/,,aids programs with development programs4,sec4 #bjc4 ,increasing program effectiveness and sustainability to achieve successful country ownership4,title ,,iii--,addressing legal and policy barriers to accessing health care,subtitle ,a--,general provisions,sec4 #cja4 ,support for laws and regulations that improve health outcomes and promote human rights4,sec4 #cjb4 ,intensifying efforts to establish effective programs for engaging key affected populations4,sec4 #cjc4 ,ensuring ,united ,states trade policy does not restrict access to affordable medicines4,subtitle ,b--,repeal of certain provisions of ,public ,law #ajh-be,sec4 #caa4 ,repeal of conscience clause requirement for eligibility for assistance4,sec4 #cab4 ,repeal of limitation on use of funds for assistance for sex workers4,sec4 #cac4 ,repeal of reporting requirement on activities promoting abstinence and related activities4,sec4 #cad4 ,effective date4,title ,,iv--,definitions,sec4 #dja4 ,definitions4 #b4 ,statement of policy ,it is the policy of the ,united ,states to achieve an ,,aids-free generation1 and to-- 7#a7 expand access to lifesaving antiretroviral therapy for people living with ,,hiv_/,,aids and immediately link people to continuous and coordinated high-quality care when they learn they are infected with ,,hiv2 7#b7 expand targeted efforts to prevent ,,hiv infection using a combination of effective1 evidence-based approaches1 including the elimination of new pediatric ,,hiv infections worldwide1 routine ,,hiv screening1 and universal access to ,,hiv prevention tools in the communities where ,,hiv_/,,aids is most heavily concentrated2 7#c7 ensure laws1 policies1 and regulations do not impede access to prevention1 treatment1 and care for people living with ,,hiv_/,,aids or at risk for acquiring ,,hiv2 7#d7 accelerate research for more efficacious ,,hiv prevention and treatments tools1 a cure1 and a vaccine2 and 7#e7 respect the human rights and dignity of persons living with ,,hiv_/,,aids4 #c4 ,findings ,the ,congress makes the following findings3 7#a7 ,an estimated #cd1jjj1jjj people around the world were living with ,,hiv at the end of #bjaj1 up from #h1jjj1jjj in #aiij4 7#b7 ,developing countries continue to bear the brunt of the ,,hiv_/,,aids epidemic1 with sub-,saharan ,africa accounting for #fh percent of all adults and children living with ,,hiv_/,,aids1 #ei percent of whom are female4 7#c7 ,despite global efforts1 #a1jjj children around the world still contract ,,hiv each day1 the majority through mother-to-child transmission of ,,hiv4 7#d7 ,,hiv prevalence among young people aged #ae to #bd has declined in many countries most impacted by ,,hiv2 nevertheless1 young people still account for #db percent of all new infections among individuals aged #ae and older4 7#e7 ,a substantial number of ,,hiv-positive women in ,,hiv care and treatment programs or prevention of mother-to-child transmission 7,,pmtct7 programs experience an unplanned pregnancy4 7#f7 ,making contraceptive services more widely available through ,,hiv care1 treatment1 and ,,pmtct programs would make it easier for women to coordinate their ,,hiv-related care with their pregnancy prevention goals1 and at the same time1 help prevent mother-to-child ,,hiv transmission4 7#g7 ,in #bjjh1 the ,tom ,lantos and ,henry ,j4 ,hyde ,united ,states ,global ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,reauthorization ,act was enacted into law1 reauthorizing the ,president's ,emergency ,plan for ,,aids ,relief 7,,pepfar7 and continued ,united ,states participation and contributions to the ,global ,fund to ,fight ,,aids1 ,tuberculosis and ,malaria4 7#h7 ,the ,united ,states ,president's ,emergency ,plan for ,,aids ,relief 7,,pepfar71 which represents the largest commitment by any nation to combat a single disease1 has saved the lives of millions of people around the world by establishing and expanding the infrastructure necessary to deliver prevention1 care1 and treatment services in low-resource settings4 7#i7 ,early detection and treatment of ,,hiv can have significant positive health effects4 ,new research demonstrates conclusively that treatment of individuals not only slows disease progression1 but can also reduce the risk of transmission to other individuals by #if percent4 7#aj7 ,in most countries ,,hiv is a disease that discriminates1 disproportionately affecting society's most vulnerable4 ,even in generalized epidemics in which a significant share of the wider population is living with ,,hiv_/,,aids1 people in vulnerable communities often have considerably higher rates of ,,hiv infection4 7#aa7 ,reaching men who have sex with men1 transgender people1 people who inject drugs1 sex workers1 and other vulnerable populations with effective ,,hiv prevention and treatment is critical to bringing the ,,aids epidemic under control4 7#ab7 ,in ,february #bjac1 the ,institute of ,medicine releases a report evaluating ,,pepfar and found that ,,pepfar1 which has provided care and treatment for more than #e million people1 has been globally transformative1 a lifeline that is restoring hope4 ,i ,global ,,hiv_/,,aids-,free ,generation ,strategy #aja4 ,global ,,hiv_/,,aids-,free ,generation ,strategy 7a7 ,strategy ,the ,president1 acting through the ,coordinator of ,united ,states ,government ,activities to ,combat ,,hiv_/,,aids ,globally1 shall establish a comprehensive1 integrated1 #e-year strategy to expand and improve efforts to combat global ,,hiv_/,,aids1 while promoting efficiency and maximizing results4 ,the strategy shall be referred to as the ,global ,,hiv_/,,aids-,free ,generation ,strategy4 7b7 ,contents ,the strategy shall-- 7#a7 accelerate progress toward achieving the ,united ,states goal of an ,,aids-free generation2 7#b7 establish a limited number of measurable targets to accelerate reductions in ,,hiv incidence and ,,hiv_/,,aids-related morbidity and mortality2 7#c7 strengthen existing and future compacts and framework agreements authorized under section #ajd;,a7d77#h7 of the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea;b-#b7;d77#h772 7#d7 strengthen engagement with diplomatic efforts at all levels of government to-- 7,a7 continue to identify and promote linkages between efforts to combat ,,hiv_/,,aids and other health development issues and human rights issues2 7,b7 encourage and assist national governments to pursue policies and legal frameworks that facilitate and enable effective responses to ,,hiv prevention1 care1 and treatment services2 and 7,c7 increase financial accountability2 and 7#e7 provide a plan to-- 7,a7 support early diagnosis and initiation of ,,hiv treatment to achieve accelerated reductions of incidence and morbidity2 7,b7 eliminate vertical transmission of ,,hiv from mother to child and support early diagnosis and initiation of ,,hiv treatment in infants and children2 7,c7 intensify efforts to expand access to voluntarily medical male circumcision1 male and female condoms and other proven-effective ,,hiv prevention interventions1 in combination with other evidence-based modalities and structural interventions2 7,d7 reduce the risk of ,,hiv infection and address the ,,hiv-related needs of sex workers1 men who have sex with men1 transgender people1 and people who inject drugs2 7,e7 increase gender equity in ,,hiv_/,,aids programs and services1 including access to voluntary family planning and reproductive health services and reducing violence and coercion2 7,f7 expand partnership with implementers1 researchers1 and academic organizations to improve the science that guides the global response to ,,hiv_/,,aids2 7,g7 provide capacity development support to increase meaningful engagement of civil society1 especially local indigenous organizations1 that work in the areas of human rights1 women's and young people's health and rights1 and gay1 lesbian1 bisexual1 and transgender rights1 in the development1 implementation1 monitoring1 and evaluation of ,united ,states-funded programs2 7,h7 advance the efforts of developing countries to develop health systems capable of managing their epidemics1 respond to broader health needs impacting affected communities1 and address new and emerging health concerns2 and 7,i7 defend1 protect1 and fulfill the human rights of people living with ,,hiv and those most at risk of ,,hiv infection4 7c7 ,consultation ,in developing the strategy1 the ,president1 acting through the ,coordinator of ,united ,states ,government ,activities to ,combat ,,hiv_/,,aids ,globally1 shall consult with-- 7#a7 each executive branch agency administering ,united ,states foreign assistance related to-- 7,a7 improving global health2 7,b7 strengthening financial management systems2 and 7,c7 monitoring and promoting human rights and democracy2 7#b7 personnel at ,united ,states embassies and country missions involved in the administration of the types of ,united ,states foreign assistance described in paragraph 7#a72 7#c7 the appropriate congressional committees with jurisdiction over the agencies described in paragraph 7#a72 7#d7 civil society and nongovernmental organizations engaged in improving health care and health outcomes in developing countries1 including indigenous community and faith-based organizations2 7#e7 international organizations engaged in improving health care and health outcomes in developing countries and of which the ,united ,states is a voting member1 with which the ,united ,states coordinates the delivery of foreign assistance1 or to which the ,united ,states contributes funding for the purpose of providing such assistance2 7#f7 academic organizations1 private foundations1 businesses1 and other organizations engaged in improving health care and health outcomes in developing countries and not receiving ,united ,states funding for such purposes2 7#g7 other donor nations engaged in improving health care and health outcomes in developing countries2 7#h7 countries receiving health-related ,united ,states foreign assistance2 7#i7 any other global1 regional1 or subregional organizations or partnerships engaged in improving health care and health outcomes in developing countries2 and 7#aj7 small1 disadvantaged1 and women-owned businesses and ,united ,states minority-serving institutions1 specifically historically ,black colleges and universities4 7d7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,president shall submit to ,congress a report that sets forth the strategy described in this section4 ,,ii ,using funds strategically to maximize results #bja4 ,support for operations research to improve program delivery1 efficiency1 impact1 and effectiveness 7a7 ,sense of ,congress ,it is the sense of the ,congress that there is a need and urgency to expand the range of interventions for preventing the transmission of ,,hiv1 including behavioral prevention research1 operations research to optimize combination ,,hiv prevention1 and research on medical technology to prevent ,,hiv infection1 including microbicides1 cost-effective female condoms1 ,pre-,exposure ,prophylaxis 7,pr,e,p71 multipurpose technologies for the prevention of ,,hiv and unintended pregnancy1 and vaccines4 7b7 ,statement of policy ,it should be the policy of the ,united ,states to ensure that efforts to combat ,,hiv_/,,aids globally should expand1 intensify1 and coordinate operations research to improve the quality1 delivery1 and impact of programming1 including with respect to-- 7#a7 services appropriate for men who have sex with men1 transgender people1 people who inject drugs1 and sex workers2 7#b7 structural interventions to remove barriers that inhibit effective implementation of ,,hiv_/,,aids-related foreign assistance1 including the analysis of laws and policies that have a negative health impact and put individuals at increased risk of ,,hiv infection2 7#c7 scalable combination of prevention and treatment approaches to ,,hiv_/,,aids2 7#d7 prevention and management of co-morbidities such as tuberculosis1 malaria1 and viral hepatitis2 and 7#e7 identification and follow up of ,,hiv-positive infants and children in resource-limited settings to increase the proportion of children accessing ,,hiv treatment and care services4 #bjb4 ,increasing coordination and integration of ,,hiv_/,,aids programs with development programs 7a7 ,statement of policy ,it should be the policy of the ,united ,states to ensure that efforts to combat ,,hiv_/,,aids globally should maximize efficiencies and the integration of services and programs to achieve reduction in ,,hiv transmission rates and the burden of ,,hiv-related morbidity and mortality1 by means that include-- 7#a7 ensuring that women and adolescent girls with ,,hiv or who are at risk of ,,hiv infection and who do not wish to become pregnant have access to voluntary contraceptive services1 including a range of contraceptive options1 and voluntary counseling to plan families1 either directly or through meaningful referrals to existing ,united ,states ,agency for ,international ,development or local family planning programs that provide counseling and a range of contraceptive options2 7#b7 integrating tuberculosis interventions with ,,hiv services1 including case-finding and tuberculosis treatment1 expanding tuberculosis preventive therapy1 and reducing other opportunistic infections that accompany ,,hiv_/,,aids2 7#c7 ensuring young people with ,,hiv are provided with confidential and affordable access to youth-friendly comprehensive sexual and reproductive health services and supplies1 including male and female condoms for the prevention of pregnancy and sexually transmitted diseases1 as relevant2 and 7#d7 working to promote and protect the human rights of people living with ,,hiv1 including men who have sex with men1 transgender people1 people who inject drugs1 sex workers1 and other vulnerable populations1 including indigenous people1 migrants1 internally displaced people1 young people1 incarcerated populations1 and people with disabilities4 7b7 ,report ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,state shall submit to the appropriate congressional committees a report describing the utilization of efficiencies in the delivery of ,,hiv_/,,aids treatment services within and between ,united ,states-funded bilateral and multilateral programs and partner countries1 including to the extent that such gains in efficiencies are being exhausted4 #bjc4 ,increasing program effectiveness and sustainability to achieve successful country ownership 7a7 ,statement of policy ,it should be the policy of the ,united ,states to ensure that efforts to combat ,,hiv_/,,aids globally should help developing countries significantly decrease the burden of ,,hiv1 strengthen and improve their health systems1 help build country ownership1 and increase financial accountability to ensure sustainability and equitable access to health services1 including by-- 7#a7 assisting developing countries create1 strengthen1 and implement their own evidence-based national ,,hiv_/,,aids strategies1 by means that include-- 7,a7 supporting early diagnosis and initiation of ,,hiv and tuberculosis treatment to achieve accelerated reductions of incidence and morbidity2 7,b7 eliminating the vertical transmission of ,,hiv from mother to child and supporting early diagnosis and initiation of ,,hiv treatment in infants and children2 7,c7 intensifying efforts to expand access to voluntary medical male circumcision1 male and female condoms1 harm reduction services1 and other proven-effective ,,hiv prevention interventions1 in combination with other evidence-based modalities1 including structural interventions2 7,d7 intensifying efforts to eliminate ,,hiv infections among populations that are often at greatest risk1 including sex workers1 men who have sex with men1 transgender individuals1 and people who inject drugs1 and addressing the ,,hiv-related needs1 including access to ,,art1 of those already infected2 7,e7 ensuring young people are provided with comprehensive knowledge1 skill-building programs1 in and out of school1 to make informed and responsible decisions for their sexual health1 and are provided with confidential and affordable access to youth-friendly comprehensive sexual and reproductive health services and supplies1 including male and female condoms2 7,f7 ensuring women with ,,hiv or who are at risk of ,,hiv infection and who do not wish to become pregnant have access to voluntary contraceptive services and commodities1 and women who desire pregnancy have access to family planning counseling and maternal health services free of judgment and discrimination2 and 7,g7 encouraging policy changes to eliminate discriminatory and stigmatizing polices that stand in the way of access to health services by marginalized and poor populations including punitive laws against ,,hiv exposure and potential transmission1 sex work1 same-sex behavior1 drug use1 and gender expression2 7#b7 supporting meaningful community involvement and participation1 inclusive of poor1 vulnerable1 or marginalized populations and their representative indigenous and civil society organizations1 in decisionmaking related to national ,,hiv_/,,aids strategies and the delivery of health services1 including in decisions related to the adoption of health policies and the total amount and distribution of health funding2 7#c7 assisting countries to coordinate1 regulate1 and harmonize the delivery of health services provided by the ,united ,states and nongovernmental organizations1 including community and faith-based organizations1 private foundations1 international organizations1 and other donors1 and to coordinate or integrate such services with the health system to the maximum extent practicable2 7#d7 using1 to the maximum extent practicable1 local and regional entities for the provision of technical assistance1 and where the capacity of such entities is insufficient1 supporting capacity building to enable such entities to provide such assistance2 7#e7 strengthening procurement and supply chain logistics to help prevent drug and commodity stock outs1 including male and female condom shortages1 and to help ensure the eventual provision of microbicides for ,,hiv prevention2 and 7#f7 providing technical assistance and support to national ministries of health1 or their equivalents1 and other relevant ministries in overseeing the health systems of their countries and monitoring and evaluating the effectiveness of such systems in reducing mortality and improving health outcomes1 including preparing for the provision of ,,hiv_/,,aids1 voluntary family planning1 non-communicable diseases1 and reproductive health services in emergency situations4 7b7 ,report ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,state shall submit to the appropriate congressional committees a report identifying benchmarks that are directly relevant to significantly decreasing the burden of the epidemic in each country receiving ,,hiv-related foreign assistance and provide context for helping countries and civil society to build country ownership4 ,,iii ,addressing legal and policy barriers to accessing health care ,a ,general provisions #cja4 ,support for laws and regulations that improve health outcomes and promote human rights ,it should be the policy of the ,united ,states to ensure that ,united ,states foreign assistance should encourage and assist national governments of developing countries to pursue policies and legal frameworks that improve health outcomes1 including policies and legal frameworks that-- 7#a7 are medically accurate and evidence-based and adhere to the latest global public health standards for prevention1 treatment1 and care2 7#b7 promote and improve the status of women and youth1 ensuring their ability to access and use health services without fear or risk of gender-based violence1 reprisal1 discrimination1 stigmatization1 arrest1 or other mistreatment2 7#c7 work to remove criminalization of1 stigmatization of1 and discrimination against poor1 vulnerable1 or marginalized populations and enact laws and policies to promote and protect the rights of such populations2 7#d7 avoid1 to the maximum extent possible1 reliance on criminal laws and sanctions to address health issues2 7#e7 incorporate relevant policy guidance that addresses structural barriers to accessing health care2 and 7#f7 prioritize the creation of a legal1 political1 and social environment that enables access to health services by all members of the population4 #cjb4 ,intensifying efforts to establish effective programs for engaging key affected populations ,it should be the policy of the ,united ,states to ensure that efforts to combat ,,hiv_/,,aids globally should intensify efforts to establish effective programs for engaging men who have sex with men1 transgender people1 people who inject drugs1 and sex workers in ,,hiv prevention1 care1 and treatment initiatives1 by means that include-- 7#a7 ensuring those eligible for treatment receive antiretroviral treatment2 7#b7 providing sterile syringes1 education1 and outreach and treatment for drug dependence for injecting drug users through a comprehensive package of services2 7#c7 providing sexual health services1 male and female condoms1 and other ,,hiv prevention services to sex workers1 their clients1 and partners2 and 7#d7 defending human rights and inherent dignity by addressing laws and practices that prevent people from accessing services and providing legal and social services to individuals and communities to facilitate access to services and to reduce violence1 stigma1 and discrimination4 #cjc4 ,ensuring ,united ,states trade policy does not restrict access to affordable medicines ,in administering title ,,iii of the ,trade ,act of #aigd 7#ai ,u4,s4,c4 #bdaa et seq471 the ,united ,states ,government shall not seek1 through negotiation or otherwise1 the revocation or revision of any intellectual property law or policy of a low- or middle-income country that regulates ,,hiv and opportunistic infection pharmaceuticals or medical technologies if the law or policy of the country-- 7#a7 promotes access to affordable ,,hiv and opportunistic infection pharmaceuticals or medical technologies for affected populations in that country2 and 7#b7 provides intellectual property protection consistent with the ,agreement on ,trade-,related ,aspects of ,intellectual ,property ,rights referred to in section #aja7;d77#ae7 of the ,uruguay ,round ,agreements ,act 7#ai ,u4,s4,c4 #ceaa7;d77#ae774 ,b ,repeal of certain provisions of ,public ,law #ajh-be #caa4 ,repeal of conscience clause requirement for eligibility for assistance ,section #cja of the ,united ,states ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,act of #bjjc 7#bb ,u4,s4,c4 #gfca7 is amended by striking subsection 7d74 #cab4 ,repeal of limitation on use of funds for assistance for sex workers ,section #cja of the ,united ,states ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,act of #bjjc 7#bb ,u4,s4,c4 #gfca71 as amended by section #caa of this ,act1 is further amended by striking subsections 7e7 and 7f74 #cac4 ,repeal of reporting requirement on activities promoting abstinence and related activities ,section #djc7;a77#b7 of the ,united ,states ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,act of #bjjc 7#bb ,u4,s4,c4 #gfgc7;a77#b77 is amended-- 7#a7 by striking 7#b7 ,prevention strategy4-- and all that follows through ,in carrying out paragraph 7#a7 and inserting 7#b7 ,prevention strategy4--,in carrying out paragraph 7#a72 and 7#b7 by striking subparagraph 7,b74 #cad4 ,effective date ,this subtitle and the amendments made by this subtitle-- 7#a7 take effect on the date of the enactment of this ,act2 and 7#b7 apply with respect to funds made available to carry out the ,united ,states ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,act of #bjjc or any amendment made by that ,act on or after such date of enactment4 ,,iv ,definitions #dja4 ,definitions ,in this ,act3 7#a7 ,appropriate congressional committees ,the term appropriate congressional committees means-- 7,a7 the ,committee on ,foreign ,affairs and the ,committee on ,appropriations of the ,house of ,representatives2 and 7,b7 the ,committee on ,foreign ,relations and the ,committee on ,appropriations of the ,senate4 7#b7 ,,aids ,the term ,,aids means the acquired immune deficiency syndrome4 7#c7 ,,hiv ,the term ,,hiv means the human immunodeficiency virus1 the pathogen that causes ,,aids4 7#d7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids means1 with respect to an individual1 an individual who is infected with ,,hiv or living with ,,aids4