PEPFAR STEWARDSHIP AND OVERSIGHT ACT OF 2013
(House of Representatives - November 19, 2013)

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[Pages H7232-H7238]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              PEPFAR STEWARDSHIP AND OVERSIGHT ACT OF 2013

  Mr. ROYCE. Mr. Speaker, I move to suspend the rules and pass the 
Senate bill (S. 1545) to extend authorities related to global HIV/AIDS 
and to promote oversight of United States programs.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                S. 1545

       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 ``PEPFAR Stewardship and 
     Oversight Act of 2013''.

     SEC. 2. INSPECTOR GENERAL OVERSIGHT.

       Section 101(f)(1) of the United States Leadership Against 
     HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7611(f)(1)) is amended--
       (1) in subparagraph (A), by striking ``5 coordinated annual 
     plans for oversight activity in each of the fiscal years 2009 
     through 2013'' and inserting ``coordinated annual plans for 
     oversight activity in each of the fiscal years 2009 through 
     2018''; and
       (2) in subparagraph (C)--
       (A) in clause (ii)--
       (i) in the heading, by striking ``Subsequent'' and 
     inserting ``2010 through 2013''; and
       (ii) by striking ``the last four plans'' and inserting 
     ``the plans for fiscal years 2010 through 2013''; and
       (B) by adding at the end the following new clause:
       ``(iii) 2014 plan.--The plan developed under subparagraph 
     (A) for fiscal year 2014 shall be completed not later than 60 
     days after the date of the enactment of the PEPFAR 
     Stewardship and Oversight Act of 2013.
       ``(iv) Subsequent plans.--Each of the last four plans 
     developed under subparagraph (A) shall be completed not later 
     than 30 days before each of the fiscal years 2015 through 
     2018, respectively.''.

     SEC. 3. ANNUAL TREATMENT STUDY.

       (a) Annual Study; Message.--Section 101(g) of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7611(g)) is amended--
       (1) in paragraph (1), by striking ``through September 30, 
     2013'' and inserting ``through September 30, 2019'';
       (2) by redesignating paragraph (2) as paragraph (3);
       (3) by inserting after paragraph (1) the following new 
     paragraph:
       ``(2) 2013 through 2018 studies.--The studies required to 
     be submitted by September 30, 2014, and annually thereafter 
     through September 30, 2018, shall include, in addition to the 
     elements set forth under paragraph (1), the following 
     elements:
       ``(A) A plan for conducting cost studies of United States 
     assistance under section 104A of the Foreign Assistance Act 
     of 1961 (22 U.S.C. 2151b-2) in partner countries, taking into 
     account the goal for more systematic collection of data, as 
     well as the demands of such analysis on available human and 
     fiscal resources.
       ``(B) A comprehensive and harmonized expenditure analysis 
     by partner country, including--
       ``(i) an analysis of Global Fund and national partner 
     spending and comparable data across United States, Global 
     Fund, and national partner spending; or
       ``(ii) where providing such comparable data is not 
     currently practicable, an explanation of why it is not 
     currently practicable, and when it will be practicable.''; 
     and
       (4) by adding at the end the following new paragraph:
       ``(4) Partner country defined.--In this subsection, the 
     term `partner country' means a country with a minimum United 
     States Government investment of HIV/AIDS assistance of at 
     least $5,000,000 in the prior fiscal year.''.

     SEC. 4. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, 
                   TUBERCULOSIS, AND MALARIA.

       (a) Limitation.--Section 202(d)(4) of the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003 (22 U.S.C. 7622(d)(4)) is amended--
       (1) in subparagraph (A)--
       (A) in clause (i), by striking ``2013'' and inserting 
     ``2018'';
       (B) in clause (ii)--
       (i) by striking ``2013'' and inserting ``2018''; and
       (ii) by striking the last two sentences; and
       (C) in clause (vi), by striking ``2013'' and inserting 
     ``2018''; and
       (2) in subparagraph (B)--
       (A) by striking ``under this subsection'' each place it 
     appears;
       (B) in clause (ii), by striking ``pursuant to the 
     authorization of appropriations under section 401'' and 
     inserting ``to carry out section 104A of the Foreign 
     Assistance Act of 1961''; and
       (C) in clause (iv), by striking ``2013'' and inserting 
     ``2018''.
       (b) Withholding Funds.--Section 202(d)(5) of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7622(d)) is amended by--
       (1) in paragraph (5)--
       (A) by striking ``2013'' and inserting ``2018'';
       (B) in subparagraph (C)--
       (i) by inserting ``in an open, machine readable format'' 
     after ``site'';
       (ii) by amending clause (v) to read as follows:
       ``(v) a regular collection, analysis, and reporting of 
     performance data and funding of grants of the Global Fund, 
     which covers all principal recipients and all subrecipients 
     on the fiscal cycle of each grant, and includes the 
     distribution of resources, by grant and principal recipient 
     and subrecipient, for prevention, care, treatment, drugs, and 
     commodities purchase, and other purposes as practicable;'';
       (C) in subparagraph (D)(ii), by inserting ``, in an open, 
     machine readable format,'' after ``audits'';
       (D) in subparagraph (E), by inserting ``, in an open, 
     machine readable format,'' after ``publicly'';
       (E) in subparagraph (F)--
       (i) in clause (i), by striking ``; and'' and inserting a 
     semicolon; and
       (ii) by striking clause (ii) and inserting the following 
     new clauses:
       ``(ii) all principal recipients and subrecipients and the 
     amount of funds disbursed to each principal recipient and 
     subrecipient on the fiscal cycle of the grant;
       ``(iii) expenditure data--

       ``(I) tracked by principal recipients and subrecipients by 
     program area, where practicable, prevention, care, and 
     treatment and reported in a format that allows comparison 
     with other funding streams in each country; or
       ``(II) if such expenditure data is not available, outlay or 
     disbursement data, and an explanation of progress made toward 
     providing such expenditure data; and

       ``(iv) high-quality grant performance evaluations measuring 
     inputs, outputs, and outcomes, as appropriate, with the goal 
     of achieving outcome reporting;''; and
       (F) by amending subparagraph (G) to read as follows:
       ``(G) has published an annual report on a publicly 
     available Web site in an open, machine readable format, that 
     includes--
       ``(i) a list of all countries imposing import duties and 
     internal taxes on any goods or services financed by the 
     Global Fund;
       ``(ii) a description of the types of goods or services on 
     which the import duties and internal taxes are levied;
       ``(iii) the total cost of the import duties and internal 
     taxes;
       ``(iv) recovered import duties or internal taxes; and
       ``(v) the status of country status-agreements;''.

     SEC. 5. ANNUAL REPORT.

       Section 104A(f) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b-2(f)) is amended to read as follows:
       ``(f) Annual Report.--
       ``(1) In general.--Not later than February 15, 2014, and 
     annually thereafter, the President shall submit to the 
     Committee on Foreign Relations of the Senate and the 
     Committee on Foreign Affairs of the House of Representatives 
     a report in an open, machine readable format, on the 
     implementation of this section for the prior fiscal year.
       ``(2) Report due in 2014.--The report due not later than 
     February 15, 2014, shall include the elements required by law 
     prior to

[[Page H7233]]

     the enactment of the PEPFAR Stewardship and Oversight Act of 
     2013.
       ``(3) Report elements.--Each report submitted after 
     February 15, 2014, shall include the following:
       ``(A) A description based on internationally available 
     data, and where practicable high-quality country-based data, 
     of the total global burden and need for HIV/AIDS prevention, 
     treatment, and care, including--
       ``(i) estimates by partner country of the global burden and 
     need; and
       ``(ii) HIV incidence, prevalence, and AIDS deaths for the 
     reporting period.
       ``(B) Reporting on annual targets across prevention, 
     treatment, and care interventions in partner countries, 
     including--
       ``(i) a description of how those targets are designed to--

       ``(I) ensure that the annual increase in new patients on 
     antiretroviral treatment exceeds the number of annual new HIV 
     infections;
       ``(II) reduce the number of new HIV infections below the 
     number of deaths among persons infected with HIV; and
       ``(III) achieve an AIDS-free generation;

       ``(ii) national targets across prevention, treatment, and 
     care that are--

       ``(I) established by partner countries; or
       ``(II) where such national partner country-developed 
     targets are unavailable, a description of progress towards 
     developing national partner country targets; and

       ``(iii) bilateral programmatic targets across prevention, 
     treatment, and care, including--

       ``(I) the number of adults and children to be directly 
     supported on HIV treatment under United States-funded 
     programs;
       ``(II) the number of adults and children to be otherwise 
     supported on HIV treatment under United States-funded 
     programs; and
       ``(III) other programmatic targets for activities directly 
     and otherwise supported by United States-funded programs.

       ``(C) A description, by partner country, of HIV/AIDS 
     funding from all sources, including funding levels from 
     partner countries, other donors, and the private sector, as 
     practicable.
       ``(D) A description of how United States-funded programs, 
     in conjunction with the Global Fund, other donors, and 
     partner countries, together set targets, measure progress, 
     and achieve positive outcomes in partner countries.
       ``(E) An annual assessment of outcome indicator 
     development, dissemination, and performance for programs 
     supported under this section, including ongoing corrective 
     actions to improve reporting.
       ``(F) A description and explanation of changes in related 
     guidance or policies related to implementation of programs 
     supported under this section.
       ``(G) An assessment and quantification of progress over the 
     reporting period toward achieving the targets set forth in 
     subparagraph (B), including--
       ``(i) the number, by partner country, of persons on HIV 
     treatment, including specifically--

       ``(I) the number of adults and children on HIV treatment 
     directly supported by United States-funded programs; and
       ``(II) the number of adults and children on HIV treatment 
     otherwise supported by United States-funded programs;

       ``(ii) HIV treatment coverage rates by partner country;
       ``(iii) the net increase in persons on HIV treatment by 
     partner country;
       ``(iv) new infections of HIV by partner country;
       ``(v) the number of HIV infections averted;
       ``(vi) antiretroviral treatment program retention rates by 
     partner country, including--

       ``(I) performance against annual targets for program 
     retention; and
       ``(II) the retention rate of persons on HIV treatment 
     directly supported by United States-funded programs; and

       ``(vii) a description of supportive care.
       ``(H) A description of partner country and United States-
     funded HIV/AIDS prevention programs and policies, including--
       ``(i) an assessment by country of progress towards targets 
     set forth in subparagraph (B), with a detailed description of 
     the metrics used to assess--

       ``(I) programs to prevent mother to child transmission of 
     HIV/AIDS, including coverage rates;
       ``(II) programs to provide or promote voluntary medical 
     male circumcision, including coverage rates;
       ``(III) programs for behavior-change; and
       ``(IV) other programmatic activities to prevent the 
     transmission of HIV;

       ``(ii) antiretroviral treatment as prevention; and
       ``(iii) a description of any new preventative interventions 
     or methodologies.
       ``(I) A description of the goals, scope, and measurement of 
     program efforts aimed at women and girls.
       ``(J) A description of the goals, scope, and measurement of 
     program efforts aimed at orphans, vulnerable children, and 
     youth.
       ``(K) A description of the indicators and milestones used 
     to assess effective, strategic, and appropriately timed 
     country ownership, including--
       ``(i) an explanation of the metrics used to determine 
     whether the pace of any transition to such ownership is 
     appropriate for that country, given that country's level of 
     readiness for such transition;
       ``(ii) an analysis of governmental and local 
     nongovernmental capacity to sustain positive outcomes;
       ``(iii) a description of measures taken to improve partner 
     country capacity to sustain positive outcomes where needed; 
     and
       ``(iv) for countries undergoing a transition to greater 
     country ownership, a description of strategies to assess and 
     mitigate programmatic and financial risk and to ensure 
     continued quality of care for essential services.
       ``(L) A description, globally and by partner country, of 
     specific efforts to achieve and incentivize greater 
     programmatic and cost effectiveness, including--
       ``(i) progress toward establishing common economic metrics 
     across prevention, care and treatment with partner countries 
     and the Global Fund;
       ``(ii) average costs, by country and by core intervention;
       ``(iii) expenditure reporting in all program areas, 
     supplemented with targeted analyses of the cost-effectiveness 
     of specific interventions; and
       ``(iv) import duties and internal taxes imposed on program 
     commodities and services, by country.
       ``(M) A description of partnership framework agreements 
     with countries, and regions where applicable, including--
       ``(i) the objectives and structure of partnership framework 
     agreements with countries, including--

       ``(I) how these agreements are aligned with national HIV/
     AIDS plans and public health strategies and commitments of 
     such countries; and
       ``(II) how these agreements incorporate a role for civil 
     society; and

       ``(ii) a description of what has been learned in advancing 
     partnership framework agreements with countries, and regions 
     as applicable, in terms of improved coordination and 
     collaboration, definition of clear roles and responsibilities 
     of participants and signers, and implications for how to 
     further strengthen these agreements with mutually accountable 
     measures of progress.
       ``(N) A description of efforts and activities to engage new 
     partners, including faith-based, locally-based, and United 
     States minority-serving institutions.
       ``(O) A definition and description of the differentiation 
     between directly and otherwise supported activities, 
     including specific efforts to clarify programmatic 
     attribution and contribution, as well as timelines for 
     dissemination and implementation.
       ``(P) A description, globally and by country, of specific 
     efforts to address co-infections and co-morbidities of HIV/
     AIDS, including--
       ``(i) the number and percent of people in HIV care or 
     treatment who started tuberculosis treatment; and
       ``(ii) the number and percentage of eligible HIV positive 
     patients starting isoniazid preventative therapy.
       ``(Q) A description of efforts by partner countries to 
     train, employ, and retain health care workers, including 
     efforts to address workforce shortages.
       ``(R) A description of program evaluations completed during 
     the reporting period, including whether all completed 
     evaluations have been published on a publically available 
     Internet website and whether any completed evaluations did 
     not adhere to the common evaluation standards of practice 
     published under paragraph (4).
       ``(4) Common evaluation standards.--Not later than February 
     1, 2014, the Global AIDS Coordinator shall publish on a 
     publically available Internet website the common evaluation 
     standards of practice referred to in paragraph (3)(R).
       ``(5) Partner country defined.--In this subsection, the 
     term `partner country' means a country with a minimum United 
     States Government investment of HIV/AIDS assistance of at 
     least $5,000,000 in the prior fiscal year.''.

     SEC. 6. ALLOCATION OF FUNDING.

       (a) Orphans and Vulnerable Children.--Section 403(b) of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7673(b)) is amended--
       (1) by striking ``2013'' and inserting ``2018''; and
       (2) by striking ``amounts appropriated pursuant to the 
     authorization of appropriations under section 401'' and 
     inserting ``amounts appropriated or otherwise made available 
     to carry out the provisions of section 104A of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 2151b-2)''.
       (b) Funding Allocation.--Section 403(c) of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7673(c)) is amended--
       (1) by striking ``2013'' and inserting ``2018''; and
       (2) by striking ``amounts appropriated for bilateral global 
     HIV/AIDS assistance pursuant to section 401'' and inserting 
     ``amounts appropriated or otherwise made available to carry 
     out the provisions of section 104A of the Foreign Assistance 
     Act of 1961 (22 U.S.C. 2151b-2)''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Royce) and the gentleman from New York (Mr. Engel) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. ROYCE. Mr. Speaker, I ask that all of our Members have 5 
legislative

[[Page H7234]]

days to revise and extend their remarks and to include any extraneous 
materials that they might wish to include on this resolution.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. ROYCE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of S. 1545. They call this the PEPFAR 
Stewardship and Oversight Act of 2013.
  It was just over a decade ago that AIDS threatened to decimate an 
entire generation of men and women and children around the world, and 
particularly in Africa. Without access to lifesaving treatment, there 
was then no incentive to get tested. Without testing, it was impossible 
to detect and prevent new infections.
  In the hardest-hit countries, an estimated 35 percent of the 
population was HIV positive, and life expectancy in those countries 
dropped to as low as 34 years.
  The global AIDS pandemic was a massive humanitarian challenge, but it 
also threatened our economic and national security. The pandemic struck 
down men and women in their most productive years. The economies of 
emerging trade partners contracted. Socioeconomic conditions 
deteriorated.
  Tens of millions of orphaned children, forced to fend for themselves, 
became vulnerable to trafficking. They became vulnerable to criminality 
and recruitment by extremists.
  Infections among security forces in southern Africa was disturbingly 
high.
  It was against this backdrop that the United States mounted the most 
significant effort of any nation to combat a single disease in history. 
Authorized by Congress in 2004, and reauthorized in 2008, the 
President's Emergency Plan For AIDS Relief, or PEPFAR, as we call it 
today, was a game-changer, and has since become among the most 
successful U.S. foreign aid programs since the Marshall Plan. Like many 
of my colleagues, I have been to Africa and witnessed the saved lives.
  Today, nearly 10 million people receive treatment supported by 
PEPFAR. Thirteen countries have reached a tipping point in their AIDS 
epidemic, the point where the number of adults on treatment exceeds the 
number of new infections. So across Africa, the new infections have 
declined by 33 percent.
  There is now hope that an AIDS-free generation may be within reach. 
We should be proud of that effort. But the United States cannot and 
should not do this alone. It is in our interest to ensure that our 
bilateral programs, our programs like PEPFAR, are complemented by an 
effective, efficient, and accountable global fund to fight AIDS, 
malaria, and tuberculosis.
  The PEPFAR Stewardship and Oversight Act of 2013 provides a framework 
for the continuation of PEPFAR's success. Among other things, this 
legislation locks in important social values provisions mandated in the 
2004 and 2008 bills that could be jettisoned if we don't move forward 
with this legislation.
  It improves transparency and reporting in a way that reflects the 
current direction of the program, and it extends limitations on U.S. 
participation in the Global Fund, including a 33 percent limitation on 
U.S. contributions and a 20 percent withholding requirement linked to 
transparency and management reforms at the Global Fund.
  So this bill is time-sensitive. During the week of December 1, the 
Global Fund will convene a donors' conference. Without the 33 percent 
cap and 20 percent withholding requirements firmly in place, which is 
what the bill does, the ability of the United States to leverage both 
our contributions and our reforms would be diminished.
  So I urge my colleagues to support this important, timely measure.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I rise in strong support of S. 1545, the 
PEPFAR Stewardship and Oversight Act, and I yield myself as much time 
as I may consume.
  I echo the words of my friend, the chairman. This important 
legislation, which passed the Senate by unanimous consent, reauthorizes 
key authorities that have helped the President's Emergency Plan For 
AIDS Relief, called PEPFAR, change the trajectory of the HIV/AIDS 
epidemic around the world.
  Before President Bush announced PEPFAR in his 2003 State of the Union 
address, and Congress passed authorizing legislation in May of that 
year, HIV and AIDS were ravaging the continent of Africa. By then, more 
than 25 million people had died from HIV/AIDS, and 14 million children 
had been left as orphans.
  Another 42 million people were infected and, though lifesaving 
treatments had been developed, far too many people had no access to the 
medications necessary to save their lives. Therefore, PEPFAR became and 
remains the largest commitment by any nation to combat a single disease 
internationally.
  Today, nearly 6 million people are receiving life-sustaining anti-
retroviral treatment.
  Last year, more than 46 million people received HIV testing and 
counseling. Of these, more than 11 million were pregnant women, and, as 
a result of treatment, the one-millionth baby was born HIV-free this 
year.
  HIV/AIDS is no longer threatening to wipe out an entire generation on 
the continent of Africa. In fact, a sustained commitment by the United 
States to fighting this epidemic has made it possible for experts and 
researchers to talk about achieving an AIDS-free generation.
  PEPFAR is in the midst of an important transition as countries take 
on greater ownership of their HIV/AIDS programs. At this critical 
juncture, the PEPFAR Stewardship and Oversight Act is an important 
demonstration of our ongoing, bipartisan support for the fight against 
HIV/AIDS.
  This legislation also contains critical provisions that will enable 
Congress to provide the oversight necessary to ensure PEPFAR continues 
to save millions of lives, while protecting our taxpayers' hard-earned 
money.
  The bill calls for continued coordination by the inspectors general 
for the State Department, Department of Health and Human Services, and 
the U.S. Agency for International Development in conducting audits and 
oversight of the PEPFAR program.
  It also requires a more robust annual report from the Office of the 
U.S. Global AIDS Coordinator, which will ensure better accountability.
  This legislation also extends key funding requirements for the 
treatment and care portion of the program, as well as funding for 
orphans and vulnerable children.
  Historically, the United States contribution to the Global Fund has 
been capped at 33 percent of total contributions. This cap has been an 
effective tool to leverage contributions from other countries, as well 
as to push for reforms, if necessary, within the Global Fund.

  However, when PEPFAR's authorization ended at the end of September, 
this 33 percent cap lapsed as well. I believe it is crucial that this 
33 percent cap be reinstated going into the Global Fund replenishment 
conference, which will be held the first week of December here in 
Washington, and this legislation would accomplish this important policy 
objective.
  Mr. Speaker, by all accounts, PEPFAR has been an incredible success 
and a program we should all be proud to be a part of.
  I would like to thank Ambassador Eric Goosby, the recently departed 
United States Global AIDS Coordinator, for his hard work on behalf of 
PEPFAR and his lifelong dedication to those living with HIV/AIDS.
  I commend Chairman Royce, Representative Lee, and Representative Ros-
Lehtinen, as well as Senator Menendez and Senator Corker, for their 
hard work on this legislation. It has been a pleasure working with all 
of them in such a bipartisan and bicameral manner.
  I would like to thank the House leadership for allowing this to come 
to the floor in a timely manner. Again, I think that Chairman Royce and 
I have shown that bipartisanship does exist in this Congress. It 
certainly exists on our Foreign Affairs Committee, and this is a 
product of that bipartisan comity.
  So I urge my colleagues to support this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROYCE. Mr. Speaker, I continue to reserve the balance of my time.

[[Page H7235]]

  Mr. ENGEL. Mr. Speaker, it is my honor to yield 4 minutes to the 
gentlewoman from California (Ms. Lee), who has been so instrumental in 
fighting for this legislation and other AIDS legislation for so many 
years in the Congress.
  Ms. LEE of California. Mr. Speaker, first, let me thank our ranking 
member for yielding, but also, let me just thank you so much for your 
tremendous leadership on this issue and on the Foreign Affairs 
Committee, and for your recognition and hard work in achieving and 
seeking to achieve an AIDS-free generation.
  I want to say it is a real pleasure to be with you today and to be 
back with you today, actually, with the committee that I served on for 
8 years. So thank you, again, so much.
  Let me also thank the chair of the Foreign Affairs Committee, 
Chairman Royce, for ensuring that PEPFAR continues as a bipartisan 
effort, and for your commitment to an AIDS-free generation. I just want 
to thank you for that leadership because, oftentimes, we wonder if 
there is bipartisanship in this body. Well, I think today, once again, 
we can cite that when it comes to saving lives, PEPFAR is a clear 
example of how we work together to do just that.

                              {time}  1645

  And, of course, I must thank my cochair on the Congressional HIV/AIDS 
Caucus, Congresswoman Ileana Ros-Lehtinen from Florida. I have to thank 
her for her work on HIV/AIDS initiatives, both international and 
domestic.
  I am very proud to have played a role in the creation of PEPFAR and 
am proud of the leadership of the Congressional Black Caucus and our 
chair at that time, the gentlewoman from Texas, Congresswoman Eddie 
Bernice Johnson. Even before the world knew about this program, 
Congresswoman Johnson knew the importance of Presidential leadership 
and put this on the Congressional Black Caucus' agenda during our very 
first meeting with President Bush.
  To quote from a 2002 letter to President Bush, the CBC called for an 
``expanded U.S. initiative'' to respond to the greatest plague in 
recorded history. And then following that, in President Bush's 2003 
State of the Union speech, he laid out what this important initiative 
should look like and made a serious commitment to this effort.
  So over the last decade, we have worked closely with the late 
Chairman Hyde, Chairman Lantos, as well as Senator Kerry, the late 
Senator Jesse Helms, Senator Bill Frist, Congressman Jim Leach, 
Congressman McDermott, Congresswoman Donna Christensen, Leader Pelosi, 
and so many others. And I share this because I think it is important 
that society recognize that the history of this has been bipartisan 
because we kept our eye on the prize. We knew that we wanted to save 
lives and we wanted to see an AIDS-free generation, and so many people, 
so many Members of this body, so many outside organizations, and our 
staff have worked so hard to get us to this point.
  So now, a decade later, I am especially proud, once again, to be a 
coauthor of the bill before us today. As I said, this is a bipartisan 
compromise, and in the end, I think we have a very good bill.
  We agreed on the need to protect funding for HIV treatment and 
programs for orphans and vulnerable children. We agreed on the need to 
preserve support and extend the expired 33 percent cap on United States 
contributions to the Global Fund. This cap is a proven tool for 
leveraging donor funding and is especially important as the United 
States prepares to host the Fourth Replenishment Conference for the 
Global Fund next month.
  Our bill also updates the annual report to better guide PEPFAR's 
transition toward greater country ownership while enhancing oversight. 
And I am especially pleased that we included reporting requirements on 
efforts to engage key stakeholders, including faith-based organizations 
and United States minority-serving institutions.
  I can tell you, as a member of the Appropriations Committee, PEPFAR 
has transitioned from--and this is very important. And I want to thank 
Ranking Member Engel and Chairman Royce for helping us realize the need 
to transition from an emergency response to a means of supporting 
country leadership in their work towards an AIDS-free generation. So 
this bill will fundamentally help continue to move our programs in that 
direction.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. ENGEL. I yield an additional 30 seconds to the gentlewoman.
  Ms. LEE of California. Thank you very much.
  I want to thank Ambassador Goosby for his tremendous leadership, who 
actually lives in my congressional district in northern California, and 
also Dr. Mark Dybul, who now leads the Global Fund, and so many more.
  PEPFAR has supported nearly 6 million people on lifesaving treatment, 
more than 11 million pregnant women who have received HIV testing and 
counseling, and 1 million babies born HIV-free this year. So this bill 
represents the real achievements that we can make when we put aside our 
differences and work together to achieve an AIDS-free generation.
  Mr. ROYCE. I reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, it is my great honor now to yield 1 minute to 
the gentlewoman from California (Ms. Pelosi), our Democratic leader who 
has, I think, done more than anyone else to fight for these things from 
almost the time that she came to Congress.
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding and for 
his kind words.
  It is just that I have been here such a long time, when I first came 
to Congress, the mere mention of the word ``AIDS'' on the floor was 
something I thought was the most natural thing to do but was something 
that some of my colleagues squirmed at. We have, indeed, come a long 
way from that time.
  So today is a proud day as Democrats and Republicans come together to 
extend and reauthorize our efforts to fight the global HIV/AIDS and 
infectious diseases in the poorest countries around the world.
  I thank Chairman Royce and Ranking Member Engel for working together 
to bring this important legislation to the floor today, and I thank 
Congresswoman Barbara Lee for her unwavering leadership on these issues 
since day one that you came to the Congress. So many of our colleagues 
deserve recognition, and the gentlewoman has acknowledged some of them.
  I will just add that this marks the 10th anniversary of the historic 
Tom Lantos and Henry Hyde U.S. Global Leadership Against AIDS, 
Tuberculosis, and Malaria Act. This legislation has been the foundation 
of the U.S. initiative to provide sustained constructive leadership in 
the global fight against AIDS.
  The original PEPFAR authorizing legislation, followed by the 
excellent work of the Appropriations Committee over the last decade, 
has provided lifesaving antiretroviral treatment, care, and prevention 
for millions of people, especially focused on the most vulnerable 
infants and children.
  I have traveled on this AIDS issue for a very long time in our 
country and abroad, and I have seen firsthand the difference that 
PEPFAR has made. I have been to clinics, as have my colleagues Mr. 
McDermott, Congresswoman Lee, the head of the Congressional Black 
Caucus Health Braintrust, Congresswoman Christensen, as well as others 
who are here, and now newer Members, Messrs. Himes and Cicilline.
  What was wonderful about it was we went to places where people were 
so poor and so desperate, but they were not so desperate that they were 
without hope. And PEPFAR gave them hope because, as they said, 
Originally we wouldn't even want anybody to know that we had AIDS. Why 
would we even be tested for AIDS? People found out that we had AIDS, 
but why would we even come to a clinic? What hope did we have?
  Well, PEPFAR gave them hope. It gave them a path.
  So today we know--and Congresswoman Lee mentioned some of the 
figures. Some bear repeating and some others I will mention:
  Treatment for over 5 million people; antiretroviral drugs for 750,000 
pregnant women living with HIV to prevent mother-to-child transmission 
of HIV averted 230,000 infant HIV infections in 2012 alone; HIV testing 
and counseling for almost 47 million people; and this

[[Page H7236]]

year, the 1 millionth baby will be born HIV-free because of PEPFAR 
support. That means a child that might have been born HIV-infected.
  Congresswoman Lee mentioned that Dr. Goosby lives in her district. 
His parents and where he was raised is in my district. So we all take 
great pride in his work.

  Over the years, we have made tremendous progress. First, with 
President Clinton, we increased the bilateral programs to fight HIV/
AIDS, and we helped create, authorize, and fund the Global Fund. Then, 
under the leadership of President Bush--and this has to be a source of 
great pride for President Bush and an important part of his legacy--we 
established PEPFAR and provided the necessary funding to ramp up the 
emergency response to the crisis.
  And I might add my thanks to Bono for the role that he played in, 
again, ramping up the resources and making sure the public understood, 
as did those of us in elected office and especially in the executive 
branch, where maybe this was a newer issue to them, that we needed to 
have the resources to make this happen. So thank you to Bono. Not only 
did he help us with the loan forgiveness to some of these same 
countries, but now to the alleviation of poverty, the eradication of 
disease. That is part of his agenda. And he worked with us to enhance 
our efforts.
  President Obama has provided leadership as well and has strengthened 
those efforts and has boosted our investments to put us on the brink of 
an AIDS-free generation. President Obama also is to be commended for 
lifting the travel ban on those with HIV, enabling the International 
AIDS Conference to return to the United States in 2012.
  I remember, as a brand-new Member attending the conference in 1987 
when this ban was in existence, it was an embarrassment that scientists 
could not come here or people coming here with HIV/AIDS from whom we 
could learn and there could be scientific collaboration. Well, that was 
not allowed because of the travel ban. So thank you, President Obama, 
for lifting it so that we could have a truly scientific, truly 
comprehensive conference in 2012 in the United States, very proudly.
  Today the Congress will pass legislation to extend our global AIDS 
investment. Even in these difficult fiscal times, we know that cutting 
back is a false economy that costs us more in the future. HIV/AIDS is 
still adapting, and so must we. It is a very resourceful virus. It just 
keeps finding ways, mutating and finding ways, and we have to be more 
resourceful in our fight against it.
  I thank the authors of the legislation, to the chair and ranking 
minority member, for bringing the bill to the floor and adapting our 
policies to meet the continued challenges posed by AIDS, TB, malaria, 
and deadly diseases around the world. I am so pleased that we will 
probably have a unanimous vote on this important bill, and that is, 
indeed, an honor to be a part of.
  Mr. ROYCE. I reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I now yield 2 minutes to the gentleman from 
Rhode Island (Mr. Cicilline), a very valued member of the Foreign 
Affairs Committee.
  Mr. CICILLINE. I thank the gentleman for yielding, and I thank 
Chairman Royce, Ranking Member Engel, Leader Pelosi, and my colleague 
Congresswoman Lee for their strong leadership.
  Mr. Speaker, as a longtime advocate for a strong government response 
to the HIV/AIDS public health crisis in my home State of Rhode Island 
and now as a member of the House Foreign Affairs Committee, I rise 
today to strongly support the President's Emergency Plan for AIDS 
Relief reauthorization.
  This year, we mark the 10th anniversary of PEPFAR, which has always 
enjoyed broad bipartisan support. First, in 2003, there was bipartisan 
support for addressing this public health emergency; then, in 2008, in 
response to some progress, PEPFAR transitioned into a more sustainable 
program with greater country ownership.
  Over the past decade, PEPFAR has significantly expanded access to 
antiretroviral therapy for those suffering from HIV and AIDS, which has 
led to a decrease in deaths from this devastating disease all around 
the world. We have made real progress because of PEPFAR, and we must 
remain vigilant and build upon this progress.
  The fight is not over. According to the World Health Organization, to 
date, almost 70 million people have been infected with the HIV virus, 
and about 35 million have died of AIDS. It is critical that the United 
States continue to be a leader in an increasingly international effort 
to eradicate this disease.
  Mr. Speaker, the role of the United States remains critical to 
combating the worldwide HIV/AIDS epidemic, and the PEPFAR Stewardship 
and Oversight Act is a necessary and commonsense piece of legislation. 
This bill extends vital authority and strengthens oversight of the 
PEPFAR program. Most importantly, the bill would also extend the 
expired 33 percent limitation on U.S. contributions to the Global Fund. 
This cap has proven to be an effective tool for leveraging funding from 
other donor countries.
  Just 30 years ago, we knew almost nothing about HIV and AIDS, and we 
were not able to treat those who were suffering from this disease. To 
have made such progress since then is remarkable, and it is a real 
testament to what we can achieve when we work together in a bipartisan 
way.
  I urge my colleagues to vote ``yes'' and to continue our efforts 
toward an AIDS-free generation which, for the first time, may be within 
our reach.
  Mr. ROYCE. I reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I now yield 2 minutes to the gentleman from 
Washington (Mr. McDermott), a classmate of mine.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, I associate myself with all the remarks 
of my friends.
  We have had a remarkable occurrence in my time in the Congress. This 
was once a death sentence. Today, we are on the verge of being able to 
produce an AIDS-free generation.
  Now, it is great and we are always excited when we do something new 
and big and exciting, but maintaining and pushing forward to finish the 
project is really where we are. This bill will pass without a vote 
against it, I am quite sure. But the real question is: What do we put 
in the budget? Because if we don't maintain what is going on in the 
world today, we will lose. We will go backward.

                              {time}  1700

  It is like we have built a dike and we are holding back the sea. But 
the fact is if we don't have the drugs available when mothers deliver 
children and you do that intervention right at the appropriate time, 
you will not prevent the children from getting it. You will not be able 
to give the long-term care to the mothers as they raise these children.
  In my view, that is really where we are.
  This was the crowning achievement, I think, of the administration of 
George Bush. His starting this was a statement to the world that the 
United States cared about an epidemic that affected the entire face of 
the universe. And we have done a good job.
  But I say this because I worry about the sequester. What does 
sequester mean to this? What will be the reductions? Because I am 
getting calls from my friends in South Africa, Zambia, Zimbabwe, 
Uganda, and Kenya, saying, How much money is there going to be next 
year? Will we be able to expand the program, keep it the same, or are 
we going to have to retrench?
  That is what the world is watching as we face this upcoming vote on 
the budget.
  I hope that we have as many votes for funding the program as we do 
for reauthorizing it here today in this bill.
  Mr. ROYCE. I continue to reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I yield 2 minutes to the gentlewoman from the 
Virgin Islands, Dr. Donna Christensen.
  Mrs. CHRISTENSEN. I thank my colleague for yielding.
  Mr. Speaker, I, too, rise today in strong support of H.R. 3177, the 
PEPFAR Stewardship and Oversight Act of 2013.
  This year marks the 10th anniversary of PEPFAR, a program that has 
literally saved lives in Africa and other hard-hit nations around the 
globe. Thanks to PEPFAR, more than 5 million people have received HIV/
AIDS

[[Page H7237]]

treatments; more than 46 million have received confidential HIV testing 
and counseling. In 2012 alone, 750,000 pregnant women living with HIV 
received antiretroviral drugs to prevent transmission to their babies.
  This bill builds on the enormous strides that PEPFAR has made in its 
10 years and bolsters oversight and reporting requirements. It also 
includes provisions that will expand international donor support, as 
well as continue to empower and enhance country ownership in health, 
thus promoting sustainability.
  Mr. Speaker, more than 100 organizations, most of which are on the 
front lines fighting this pandemic throughout Asia, Africa, Middle 
East, the Caribbean, and other highly affected countries, strongly 
support this bill. Our HBCUs, who have an important role to play, have 
also been advocates for it.
  I have visited PEPFAR programs in Africa and the Caribbean and seen 
their effectiveness firsthand. They save lives.
  As a physician who practiced for more than 20 years before coming 
here, I know what happens when individuals who are at great risk for 
HIV infection do not get accurate testing, education, and counseling, 
or when those who are infected do not receive antiretroviral drugs. The 
outcome is disastrous.
  As a Member representing a U.S. territory in the Caribbean--the 
world's second hardest hit region by HIV/AIDS--I cannot stress more 
strongly how vitally important our passing the PEPFAR Stewardship and 
Oversight Act of 2013 is today. The lives of millions of individuals in 
our global community who are currently battling HIV/AIDS depend upon 
it. The health and wellness of millions more who are at risk for 
infection but currently HIV-free depend on it.
  We have not agreed on much that is health and health care-related as 
of late, but this is one bill that we can, and I am sure will, agree 
on. So I strongly urge all my colleagues to support H.R. 3177.
  Mr. ROYCE. I continue to reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, may I ask how much time is remaining.
  The SPEAKER pro tempore. The gentleman for New York has 4 minutes 
remaining.
  Mr. ENGEL. I yield 2 minutes to the gentleman from Connecticut (Mr. 
Himes).
  Mr. HIMES. Mr. Speaker, I thank Mr. Engel for yielding.
  I would like to thank the chairman and the ranking member of the 
Foreign Affairs Committee for the bipartisanship with which they led 
this bill and which I think we will accomplish some very good things 
tomorrow.
  The figures around this program speak for themselves: the millions of 
lives saved, the orphanages which are no longer full, the many pregnant 
women who will not transmit a deadly virus to their children. These 
things speak for themselves.
  Without question, PEPFAR and the Global Fund are two of the most 
effective foreign aid programs ever conceived in this Chamber. But 
Americans might ask in good faith, Why spend money in places like 
Africa, Asia, and in the Caribbean when the needs are so intense right 
here at home? And the answer to that question could not be clearer.
  Africa and Asia, where PEPFAR and the Global Fund do the most good, 
are areas of great instability but of great promise, where countries 
like China are buying up commodities, are exerting their influence, and 
are throwing their weight around.
  We have the opportunity through the continuation of programs such as 
PEPFAR and the Global Fund to win for generations the hearts and minds 
of people who will think back on American assistance as the reason that 
their family had continuity, as the reason that their country continued 
to develop.
  So the question we are answering when we think about continuing these 
programs and our involvement and our taxpayer dollars should really be, 
Are we a country that offered the opportunity to continue to save 
lives? Will we do that? Do we want to save lives, if we can? Do we want 
to be known just for our economic and military strengths, or do we want 
to also be known as an unqualified force for good in this world?
  I would say that at this point in our history our ability to say that 
it is not just about economic and military power, but it is about a 
quality of mercy that we all cherish. And this is a wonderful 
opportunity for us to say who we are by supporting this legislation.
  Mr. ROYCE. I continue to reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I am very happy to yield 1 minute to the 
gentlewoman from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Mr. Speaker, we can celebrate PEPFAR's 10 years of 
success in saving millions of lives by passing the bipartisan PEPFAR 
Stewardship and Oversight Act.
  Nearly 6 million people are receiving life-sustaining anti-retroviral 
treatments and providing care and support to more than 4.5 million 
orphans and vulnerable children. That is PEPFAR.
  This bill extends critical authorities and strengthens program 
oversight to ensure access to essential prevention and treatment 
services. Most importantly, this bill extends existing funding 
requirements for treatment of orphans and vulnerable children.

  We have brought to the world a tipping point in the fight against 
AIDS, and I urge all my colleagues to vote ``yes'' on this very 
important bill. I thank my colleagues, like Barbara Lee, who have 
supported and initiated this amazing help for saving millions of lives.
  Mr. ROYCE. I continue to reserve the balance of my time.
  Mr. ENGEL. Mr. Speaker, I yield myself the balance of my time.
  In closing, let me just, again, say what I said at the outset. I want 
to thank Chairman Royce. I am really proud of this legislation. It is 
truly a bipartisan product.
  We are doing something really, really good here today. We are doing 
something that we can be proud of today. We are saving lives, and we 
are showing once again that the United States is the most compassionate 
Nation on Earth. When all is said and done, isn't this really one of 
the greatest things that we can do?
  So I urge my colleagues on both sides of the aisle to support this 
bill, and I yield back the balance of my time.
  Mr. ROYCE. Mr. Speaker, I do think Mr. Eliot Engel of New York should 
feel proud about this bill. He is the original author of the House-
passed version.
  I would say that, in the interest of expediting this measure, we on 
the Foreign Affairs Committee worked, frankly, not only across party 
lines but across Chambers in order to draft legislation that preserves 
congressional prerogatives, that advances U.S. interests, and, as Eliot 
Engel said so succinctly, that saves lives. This bill does that. It 
achieves these objectives. We worked in tandem with the Senate on Mr. 
Engel's original draft to get this done.
  This bill does not affect direct spending. It doesn't affect 
revenues. It does not create new programs or include major new policy 
provisions. I want the Members to understand that.
  It is a streamlined, bipartisan measure that does extend critical 
PEPFAR authorities that expired, and it maintains the gains achieved 
through the 2008 reauthorization process.
  Besides the leadership of Mr. Engel on this bill, I would like to 
recognize the work of Representatives Ros-Lehtinen and Lee to shape 
this measure, as well as efforts by our leadership to ensure that we do 
not miss this narrow window of opportunity to send this bill to the 
President's desk without further delay.
  I would also share with our Members that it helps get us on a path 
towards graduating countries from assistance. It conditions and limits 
assistance to the Global Fund.
  I urge my colleagues to support this bill, and I yield back the 
balance of my time.
  Mr. WAXMAN. Mr. Speaker, I rise today in support of S. 1545, the 
PEPFAR Stewardship and Oversight Act. Since its establishment in 2003, 
the U.S. President's Emergency Plan for AIDS Relief, known as PEPFAR, 
has become arguably the most effective global health program that the 
U.S. government has ever administered. Already, nearly 15 million AIDS 
victims have been served; let us not stop there.
  The HIV/AIDS epidemic threatened to eliminate an entire generation in 
Africa. Economies were threatened and health care systems were wholly 
unequipped to handle the magnitude of the epidemic. Through PEPFAR, the

[[Page H7238]]

U.S. government and its local partners provided diagnostic testing, 
administered antiretroviral treatment (ART), and expanded HIV/AIDS 
programs to lower the rate of transmission. These efforts achieved 
significant success. This year the millionth HIV-free baby was born due 
to PEPFAR-supported prevention of mother-to-child transmission. In 13 
countries, the rate of infection is below the increasing rate of adults 
requiring treatment. Now we can finally work toward an AIDS-free 
generation.
  S. 1545 extends our commitment to PEPFAR and the U.N. Global Fund 
through 2018. It maintains the 10 percent funding requirement for 
orphans and vulnerable children, and at least 51 percent for treatment 
programs. This bill does not address the changing priorities in the 
second phase of PEPFAR, giving PEPFAR the bandwidth to strengthen 
health systems, explore public-private partnerships, and increase 
country ownership.
  Local partnership and ownership is essential to the sustainability of 
PEPFAR's programs. This partnership has already begun; the effects can 
be seen in broader administration of medical services, though the 
parallel expansion of social services for the HIV community has lagged. 
The continuation of the 33 percent funding cap for the U.N. Global Fund 
ensures local partnership to address such problems.
  One of the most notable changes to this legislation is its increase 
in oversight. I look forward to receiving the annual, joint oversight 
and auditing plans that will be developed by the Inspectors General of 
the Department of State, USAID, and HHS, thus increasing Congressional 
oversight as well. It will include per-patient cost studies and 
analysis of the shift toward greater country ownership. PEPFAR is no 
longer a start-up program, and the oversight associated with its shift 
toward long-term sustainability must be adjusted accordingly.
  Yesterday, the Senate passed this bill with unanimous consent. It is 
our turn to do the same.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in 
support of S. 1545, The President's Emergency Plan for AIDS Relief 
Stewardship and Oversight Act (PEPFAR). Eleven years ago, as the Chair 
of the Congressional Black Caucus, I initiated PEPFAR talks with 
President George Bush to discuss the necessity of an international 
response to the HIV/AIDS pandemic. President Bush helped make a $15 
billion commitment to worldwide AIDS relief.
  Not only has PEPFAR driven down the cost of commodities, it has seen 
real success targeting each country's specific epidemic by coordinating 
resources within numerous AIDS responses.
  PEPFAR is a vital emergency response and it has been able to 
transition to long-term sustainability through country ownership. This 
bill not only strengthens all that PEPFAR has achieved, it extends 
critical oversight and authority in order to continue its success.
  While PEPFAR has been a major accomplishment, we must continue to 
support its efforts. The U.S. investment in the Global Fund is key to 
the success of PEPFAR.
  Our contributions have not only secured resources but also helped to 
increase coverage of health services and saved millions of lives. I 
urge my colleagues to vote in favor of S. 1545 and continue to support 
this critical program.
  The SPEAKER pro tempore (Mr. Wenstrup). The question is on the motion 
offered by the gentleman from California (Mr. Royce) that the House 
suspend the rules and pass the bill, S. 1545.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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