Text of US HB 3117 (2013)

I 113TH CONGRESS 1ST SESSION H. R. 3117 To bring an end to the spread of HIV/AIDS in the United States and around the world. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 17, 2013 Ms. LEE of California introduced the following bill; which was referred to the Committee on Foreign Affairs, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned A BILL To bring an end to the spread of HIV/AIDS in the United States and around the world. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Ending the HIV/AIDS Epidemic Act of 2013’’. 5 (b) TABLE OF CONTENTS.—The table of contents of 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Statement of policy. Sec. 3. Findings. VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 2 •HR 3117 IH TITLE I—GLOBAL HIV/AIDS-FREE GENERATION STRATEGY Sec. 101. Global HIV/AIDS-Free Generation Strategy. TITLE II—USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS Sec. 201. Support for operations research to improve program delivery, effi- ciency, impact, and effectiveness. Sec. 202. Increasing coordination and integration of HIV/AIDS programs with development programs. Sec. 203. Increasing program effectiveness and sustainability to achieve suc- cessful country ownership. TITLE III—ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH CARE Subtitle A—General Provisions Sec. 301. Support for laws and regulations that improve health outcomes and promote human rights. Sec. 302. Intensifying efforts to establish effective programs for engaging key affected populations. Sec. 303. Ensuring United States trade policy does not restrict access to af- fordable medicines. Subtitle B—Repeal of Certain Provisions of Public Law 108–25 Sec. 311. Repeal of ‘‘conscience clause’’ requirement for eligibility for assist- ance. Sec. 312. Repeal of limitation on use of funds for assistance for sex workers. Sec. 313. Repeal of reporting requirement on activities promoting abstinence and related activities. Sec. 314. Effective date. TITLE IV—DEFINITIONS Sec. 401. Definitions. SEC. 2. STATEMENT OF POLICY. 1 It is the policy of the United States to achieve an 2 AIDS-free generation, and to— 3 (1) expand access to lifesaving antiretroviral 4 therapy for people living with HIV/AIDS and imme- 5 diately link people to continuous and coordinated 6 high-quality care when they learn they are infected 7 with HIV; 8 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 3 •HR 3117 IH (2) expand targeted efforts to prevent HIV in- 1 fection using a combination of effective, evidence- 2 based approaches, including the elimination of new 3 pediatric HIV infections worldwide, routine HIV 4 screening, and universal access to HIV prevention 5 tools in the communities where HIV/AIDS is most 6 heavily concentrated; 7 (3) ensure laws, policies, and regulations do not 8 impede access to prevention, treatment, and care for 9 people living with HIV/AIDS or at risk for acquiring 10 HIV; 11 (4) accelerate research for more efficacious HIV 12 prevention and treatments tools, a cure, and a vac- 13 cine; and 14 (5) respect the human rights and dignity of 15 persons living with HIV/AIDS. 16 SEC. 3. FINDINGS. 17 The Congress makes the following findings: 18 (1) An estimated 34,000,000 people around the 19 world were living with HIV at the end of 2010, up 20 from 8,000,000 in 1990. 21 (2) Developing countries continue to bear the 22 brunt of the HIV/AIDS epidemic, with sub-Saharan 23 Africa accounting for 68 percent of all adults and 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 4 •HR 3117 IH children living with HIV/AIDS, 59 percent of whom 1 are female. 2 (3) Despite global efforts, 1,000 children 3 around the world still contract HIV each day, the 4 majority through mother-to-child transmission of 5 HIV. 6 (4) HIV prevalence among young people aged 7 15 to 24 has declined in many countries most im- 8 pacted by HIV; nevertheless, young people still ac- 9 count for 42 percent of all new infections among in- 10 dividuals aged 15 and older. 11 (5) A substantial number of HIV-positive 12 women in HIV care and treatment programs or pre- 13 vention of mother-to-child transmission (PMTCT) 14 programs experience an unplanned pregnancy. 15 (6) Making contraceptive services more widely 16 available through HIV care, treatment, and PMTCT 17 programs would make it easier for women to coordi- 18 nate their HIV-related care with their pregnancy 19 prevention goals, and at the same time, help prevent 20 mother-to-child HIV transmission. 21 (7) In 2008, the Tom Lantos and Henry J. 22 Hyde United States Global Leadership Against HIV/ 23 AIDS, Tuberculosis, and Malaria Reauthorization 24 Act was enacted into law, reauthorizing the Presi- 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 5 •HR 3117 IH dent’s Emergency Plan for AIDS Relief (PEPFAR) 1 and continued United States participation and con- 2 tributions to the Global Fund to Fight AIDS, Tu- 3 berculosis and Malaria. 4 (8) The United States President’s Emergency 5 Plan for AIDS Relief (PEPFAR), which represents 6 the largest commitment by any nation to combat a 7 single disease, has saved the lives of millions of peo- 8 ple around the world by establishing and expanding 9 the infrastructure necessary to deliver prevention, 10 care, and treatment services in low-resource settings. 11 (9) Early detection and treatment of HIV can 12 have significant positive health effects. New research 13 demonstrates conclusively that treatment of individ- 14 uals not only slows disease progression, but can also 15 reduce the risk of transmission to other individuals 16 by 96 percent. 17 (10) In most countries HIV is a disease that 18 discriminates, disproportionately affecting society’s 19 most vulnerable. Even in generalized epidemics in 20 which a significant share of the wider population is 21 living with HIV/AIDS, people in vulnerable commu- 22 nities often have considerably higher rates of HIV 23 infection. 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 6 •HR 3117 IH (11) Reaching men who have sex with men, 1 transgender people, people who inject drugs, sex 2 workers, and other vulnerable populations with effec- 3 tive HIV prevention and treatment is critical to 4 bringing the AIDS epidemic under control. 5 (12) In February 2013, the Institute of Medi- 6 cine releases a report evaluating PEPFAR and 7 found that PEPFAR, which has provided care and 8 treatment for more than 5 million people, has been 9 ‘‘globally transformative’’, a ‘‘lifeline’’ that is ‘‘re- 10 storing hope’’. 11 TITLE I—GLOBAL HIV/AIDS-FREE 12 GENERATION STRATEGY 13 SEC. 101. GLOBAL HIV/AIDS-FREE GENERATION STRATEGY. 14 (a) STRATEGY.—The President, acting through the 15 Coordinator of United States Government Activities to 16 Combat HIV/AIDS Globally, shall establish a comprehen- 17 sive, integrated, 5-year strategy to expand and improve 18 efforts to combat global HIV/AIDS, while promoting effi- 19 ciency and maximizing results. The strategy shall be re- 20 ferred to as the ‘‘Global HIV/AIDS-Free Generation 21 Strategy’’. 22 (b) CONTENTS.—The strategy shall— 23 (1) accelerate progress toward achieving the 24 United States goal of an AIDS-free generation; 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 7 •HR 3117 IH (2) establish a limited number of measurable 1 targets to accelerate reductions in HIV incidence 2 and HIV/AIDS-related morbidity and mortality; 3 (3) strengthen existing and future compacts 4 and framework agreements authorized under section 5 104A(d)(8) of the Foreign Assistance Act of 1961 6 (22 U.S.C. 2151b–2(d)(8)); 7 (4) strengthen engagement with diplomatic ef- 8 forts at all levels of government to— 9 (A) continue to identify and promote link- 10 ages between efforts to combat HIV/AIDS and 11 other health development issues and human 12 rights issues; 13 (B) encourage and assist national govern- 14 ments to pursue policies and legal frameworks 15 that facilitate and enable effective responses to 16 HIV prevention, care, and treatment services; 17 and 18 (C) increase financial accountability; and 19 (5) provide a plan to— 20 (A) support early diagnosis and initiation 21 of HIV treatment to achieve accelerated reduc- 22 tions of incidence and morbidity; 23 (B) eliminate vertical transmission of HIV 24 from mother to child and support early diag- 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 8 •HR 3117 IH nosis and initiation of HIV treatment in infants 1 and children; 2 (C) intensify efforts to expand access to 3 voluntarily medical male circumcision, male and 4 female condoms and other proven-effective HIV 5 prevention interventions, in combination with 6 other evidence-based modalities and structural 7 interventions; 8 (D) reduce the risk of HIV infection and 9 address the HIV-related needs of sex workers, 10 men who have sex with men, transgender peo- 11 ple, and people who inject drugs; 12 (E) increase gender equity in HIV/AIDS 13 programs and services, including access to vol- 14 untary family planning and reproductive health 15 services and reducing violence and coercion; 16 (F) expand partnership with implementers, 17 researchers, and academic organizations to im- 18 prove the science that guides the global re- 19 sponse to HIV/AIDS; 20 (G) provide capacity development support 21 to increase meaningful engagement of civil soci- 22 ety, especially local indigenous organizations, 23 that work in the areas of human rights, wom- 24 en’s and young people’s health and rights, and 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 9 •HR 3117 IH gay, lesbian, bisexual, and transgender rights, 1 in the development, implementation, moni- 2 toring, and evaluation of United States-funded 3 programs; 4 (H) advance the efforts of developing coun- 5 tries to develop health systems capable of man- 6 aging their epidemics, respond to broader 7 health needs impacting affected communities, 8 and address new and emerging health concerns; 9 and 10 (I) defend, protect, and fulfill the human 11 rights of people living with HIV and those most 12 at risk of HIV infection. 13 (c) CONSULTATION.—In developing the strategy, the 14 President, acting through the Coordinator of United 15 States Government Activities to Combat HIV/AIDS Glob- 16 ally, shall consult with— 17 (1) each executive branch agency administering 18 United States foreign assistance related to— 19 (A) improving global health; 20 (B) strengthening financial management 21 systems; and 22 (C) monitoring and promoting human 23 rights and democracy; 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 10 •HR 3117 IH (2) personnel at United States embassies and 1 country missions involved in the administration of 2 the types of United States foreign assistance de- 3 scribed in paragraph (1); 4 (3) the appropriate congressional committees 5 with jurisdiction over the agencies described in para- 6 graph (1); 7 (4) civil society and nongovernmental organiza- 8 tions engaged in improving health care and health 9 outcomes in developing countries, including indige- 10 nous community and faith-based organizations; 11 (5) international organizations engaged in im- 12 proving health care and health outcomes in devel- 13 oping countries and of which the United States is a 14 voting member, with which the United States coordi- 15 nates the delivery of foreign assistance, or to which 16 the United States contributes funding for the pur- 17 pose of providing such assistance; 18 (6) academic organizations, private foundations, 19 businesses, and other organizations engaged in im- 20 proving health care and health outcomes in devel- 21 oping countries and not receiving United States 22 funding for such purposes; 23 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 11 •HR 3117 IH (7) other donor nations engaged in improving 1 health care and health outcomes in developing coun- 2 tries; 3 (8) countries receiving health-related United 4 States foreign assistance; 5 (9) any other global, regional, or subregional 6 organizations or partnerships engaged in improving 7 health care and health outcomes in developing coun- 8 tries; and 9 (10) small, disadvantaged, and women-owned 10 businesses and United States minority-serving insti- 11 tutions, specifically historically Black colleges and 12 universities. 13 (d) REPORT.—Not later than 1 year after the date 14 of the enactment of this Act, the President shall submit 15 to Congress a report that sets forth the strategy described 16 in this section. 17 TITLE II—USING FUNDS STRATE- 18 GICALLY TO MAXIMIZE RE- 19 SULTS 20 SEC. 201. SUPPORT FOR OPERATIONS RESEARCH TO IM- 21 PROVE PROGRAM DELIVERY, EFFICIENCY, 22 IMPACT, AND EFFECTIVENESS. 23 (a) SENSE OF CONGRESS.—It is the sense of the Con- 24 gress that there is a need and urgency to expand the range 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 12 •HR 3117 IH of interventions for preventing the transmission of HIV, 1 including behavioral prevention research, operations re- 2 search to optimize combination HIV prevention, and re- 3 search on medical technology to prevent HIV infection, in- 4 cluding microbicides, cost-effective female condoms, Pre- 5 Exposure Prophylaxis (PrEP), multipurpose technologies 6 for the prevention of HIV and unintended pregnancy, and 7 vaccines. 8 (b) STATEMENT OF POLICY.—It should be the policy 9 of the United States to ensure that efforts to combat HIV/ 10 AIDS globally should expand, intensify, and coordinate 11 operations research to improve the quality, delivery, and 12 impact of programming, including with respect to— 13 (1) services appropriate for men who have sex 14 with men, transgender people, people who inject 15 drugs, and sex workers; 16 (2) structural interventions to remove barriers 17 that inhibit effective implementation of HIV/AIDS- 18 related foreign assistance, including the analysis of 19 laws and policies that have a negative health impact 20 and put individuals at increased risk of HIV infec- 21 tion; 22 (3) scalable combination of prevention and 23 treatment approaches to HIV/AIDS; 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 13 •HR 3117 IH (4) prevention and management of co- 1 morbidities such as tuberculosis, malaria, and viral 2 hepatitis; and 3 (5) identification and follow up of HIV-positive 4 infants and children in resource-limited settings to 5 increase the proportion of children accessing HIV 6 treatment and care services. 7 SEC. 202. INCREASING COORDINATION AND INTEGRATION 8 OF HIV/AIDS PROGRAMS WITH DEVELOP- 9 MENT PROGRAMS. 10 (a) STATEMENT OF POLICY.—It should be the policy 11 of the United States to ensure that efforts to combat HIV/ 12 AIDS globally should maximize efficiencies and the inte- 13 gration of services and programs to achieve reduction in 14 HIV transmission rates and the burden of HIV-related 15 morbidity and mortality, by means that include— 16 (1) ensuring that women and adolescent girls 17 with HIV or who are at risk of HIV infection and 18 who do not wish to become pregnant have access to 19 voluntary contraceptive services, including a range of 20 contraceptive options, and voluntary counseling to 21 plan families, either directly or through meaningful 22 referrals to existing United States Agency for Inter- 23 national Development or local family planning pro- 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 14 •HR 3117 IH grams that provide counseling and a range of con- 1 traceptive options; 2 (2) integrating tuberculosis interventions with 3 HIV services, including case-finding and tuberculosis 4 treatment, expanding tuberculosis preventive ther- 5 apy, and reducing other opportunistic infections that 6 accompany HIV/AIDS; 7 (3) ensuring young people with HIV are pro- 8 vided with confidential and affordable access to 9 youth-friendly comprehensive sexual and reproduc- 10 tive health services and supplies, including male and 11 female condoms for the prevention of pregnancy and 12 sexually transmitted diseases, as relevant; and 13 (4) working to promote and protect the human 14 rights of people living with HIV, including men who 15 have sex with men, transgender people, people who 16 inject drugs, sex workers, and other vulnerable popu- 17 lations, including indigenous people, migrants, inter- 18 nally displaced people, young people, incarcerated 19 populations, and people with disabilities. 20 (b) REPORT.—Not later than 180 days after the date 21 of the enactment of this Act, the Secretary of State shall 22 submit to the appropriate congressional committees a re- 23 port describing the utilization of efficiencies in the delivery 24 of HIV/AIDS treatment services within and between 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 15 •HR 3117 IH United States-funded bilateral and multilateral programs 1 and partner countries, including to the extent that such 2 gains in efficiencies are being exhausted. 3 SEC. 203. INCREASING PROGRAM EFFECTIVENESS AND 4 SUSTAINABILITY TO ACHIEVE SUCCESSFUL 5 COUNTRY OWNERSHIP. 6 (a) STATEMENT OF POLICY.—It should be the policy 7 of the United States to ensure that efforts to combat HIV/ 8 AIDS globally should help developing countries signifi- 9 cantly decrease the burden of HIV, strengthen and im- 10 prove their health systems, help build country ownership, 11 and increase financial accountability to ensure sustain- 12 ability and equitable access to health services, including 13 by— 14 (1) assisting developing countries create, 15 strengthen, and implement their own evidence-based 16 national HIV/AIDS strategies, by means that in- 17 clude— 18 (A) supporting early diagnosis and initi- 19 ation of HIV and tuberculosis treatment to 20 achieve accelerated reductions of incidence and 21 morbidity; 22 (B) eliminating the vertical transmission of 23 HIV from mother to child and supporting early 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 16 •HR 3117 IH diagnosis and initiation of HIV treatment in in- 1 fants and children; 2 (C) intensifying efforts to expand access to 3 voluntary medical male circumcision, male and 4 female condoms, harm reduction services, and 5 other proven-effective HIV prevention interven- 6 tions, in combination with other evidence-based 7 modalities, including structural interventions; 8 (D) intensifying efforts to eliminate HIV 9 infections among populations that are often at 10 greatest risk, including sex workers, men who 11 have sex with men, transgender individuals, and 12 people who inject drugs, and addressing the 13 HIV-related needs, including access to ART, of 14 those already infected; 15 (E) ensuring young people are provided 16 with comprehensive knowledge, skill-building 17 programs, in and out of school, to make in- 18 formed and responsible decisions for their sex- 19 ual health, and are provided with confidential 20 and affordable access to youth-friendly com- 21 prehensive sexual and reproductive health serv- 22 ices and supplies, including male and female 23 condoms; 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 17 •HR 3117 IH (F) ensuring women with HIV or who are 1 at risk of HIV infection and who do not wish 2 to become pregnant have access to voluntary 3 contraceptive services and commodities, and 4 women who desire pregnancy have access to 5 family planning counseling and maternal health 6 services free of judgment and discrimination; 7 and 8 (G) encouraging policy changes to elimi- 9 nate discriminatory and stigmatizing polices 10 that stand in the way of access to health serv- 11 ices by marginalized and poor populations in- 12 cluding punitive laws against HIV exposure and 13 potential transmission, sex work, same-sex be- 14 havior, drug use, and gender expression; 15 (2) supporting meaningful community involve- 16 ment and participation, inclusive of poor, vulnerable, 17 or marginalized populations and their representative 18 indigenous and civil society organizations, in deci- 19 sionmaking related to national HIV/AIDS strategies 20 and the delivery of health services, including in deci- 21 sions related to the adoption of health policies and 22 the total amount and distribution of health funding; 23 (3) assisting countries to coordinate, regulate, 24 and harmonize the delivery of health services pro- 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 18 •HR 3117 IH vided by the United States and nongovernmental or- 1 ganizations, including community and faith-based 2 organizations, private foundations, international or- 3 ganizations, and other donors, and to coordinate or 4 integrate such services with the health system to the 5 maximum extent practicable; 6 (4) using, to the maximum extent practicable, 7 local and regional entities for the provision of tech- 8 nical assistance, and where the capacity of such enti- 9 ties is insufficient, supporting capacity building to 10 enable such entities to provide such assistance; 11 (5) strengthening procurement and supply 12 chain logistics to help prevent drug and commodity 13 stock outs, including male and female condom short- 14 ages, and to help ensure the eventual provision of 15 microbicides for HIV prevention; and 16 (6) providing technical assistance and support 17 to national ministries of health, or their equivalents, 18 and other relevant ministries in overseeing the 19 health systems of their countries and monitoring and 20 evaluating the effectiveness of such systems in re- 21 ducing mortality and improving health outcomes, in- 22 cluding preparing for the provision of HIV/AIDS, 23 voluntary family planning, non-communicable dis- 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 19 •HR 3117 IH eases, and reproductive health services in emergency 1 situations. 2 (b) REPORT.—Not later than 180 days after the date 3 of the enactment of this Act, the Secretary of State shall 4 submit to the appropriate congressional committees a re- 5 port identifying benchmarks that are directly relevant to 6 significantly decreasing the burden of the epidemic in each 7 country receiving HIV-related foreign assistance and pro- 8 vide context for helping countries and civil society to build 9 country ownership. 10 TITLE III—ADDRESSING LEGAL 11 AND POLICY BARRIERS TO 12 ACCESSING HEALTH CARE 13 Subtitle A—General Provisions 14 SEC. 301. SUPPORT FOR LAWS AND REGULATIONS THAT IM- 15 PROVE HEALTH OUTCOMES AND PROMOTE 16 HUMAN RIGHTS. 17 It should be the policy of the United States to ensure 18 that United States foreign assistance should encourage 19 and assist national governments of developing countries 20 to pursue policies and legal frameworks that improve 21 health outcomes, including policies and legal frameworks 22 that— 23 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 20 •HR 3117 IH (1) are medically accurate and evidence-based 1 and adhere to the latest global public health stand- 2 ards for prevention, treatment, and care; 3 (2) promote and improve the status of women 4 and youth, ensuring their ability to access and use 5 health services without fear or risk of gender-based 6 violence, reprisal, discrimination, stigmatization, ar- 7 rest, or other mistreatment; 8 (3) work to remove criminalization of, stig- 9 matization of, and discrimination against poor, vul- 10 nerable, or marginalized populations and enact laws 11 and policies to promote and protect the rights of 12 such populations; 13 (4) avoid, to the maximum extent possible, reli- 14 ance on criminal laws and sanctions to address 15 health issues; 16 (5) incorporate relevant policy guidance that 17 addresses structural barriers to accessing health 18 care; and 19 (6) prioritize the creation of a legal, political, 20 and social environment that enables access to health 21 services by all members of the population. 22 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 21 •HR 3117 IH SEC. 302. INTENSIFYING EFFORTS TO ESTABLISH EFFEC- 1 TIVE PROGRAMS FOR ENGAGING KEY AF- 2 FECTED POPULATIONS. 3 It should be the policy of the United States to ensure 4 that efforts to combat HIV/AIDS globally should intensify 5 efforts to establish effective programs for engaging men 6 who have sex with men, transgender people, people who 7 inject drugs, and sex workers in HIV prevention, care, and 8 treatment initiatives, by means that include— 9 (1) ensuring those eligible for treatment receive 10 antiretroviral treatment; 11 (2) providing sterile syringes, education, and 12 outreach and treatment for drug dependence for in- 13 jecting drug users through a comprehensive package 14 of services; 15 (3) providing sexual health services, male and 16 female condoms, and other HIV prevention services 17 to sex workers, their clients, and partners; and 18 (4) defending human rights and inherent dig- 19 nity by addressing laws and practices that prevent 20 people from accessing services and providing legal 21 and social services to individuals and communities to 22 facilitate access to services and to reduce violence, 23 stigma, and discrimination. 24 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 22 •HR 3117 IH SEC. 303. ENSURING UNITED STATES TRADE POLICY DOES 1 NOT RESTRICT ACCESS TO AFFORDABLE 2 MEDICINES. 3 In administering title III of the Trade Act of 1974 4 (19 U.S.C. 2411 et seq.), the United States Government 5 shall not seek, through negotiation or otherwise, the rev- 6 ocation or revision of any intellectual property law or pol- 7 icy of a low- or middle-income country that regulates HIV 8 and opportunistic infection pharmaceuticals or medical 9 technologies if the law or policy of the country— 10 (1) promotes access to affordable HIV and op- 11 portunistic infection pharmaceuticals or medical 12 technologies for affected populations in that country; 13 and 14 (2) provides intellectual property protection 15 consistent with the Agreement on Trade-Related As- 16 pects of Intellectual Property Rights referred to in 17 section 101(d)(15) of the Uruguay Round Agree- 18 ments Act (19 U.S.C. 3511(d)(15)). 19 Subtitle B—Repeal of Certain 20 Provisions of Public Law 108–25 21 SEC. 311. REPEAL OF ‘‘CONSCIENCE CLAUSE’’ REQUIRE- 22 MENT FOR ELIGIBILITY FOR ASSISTANCE. 23 Section 301 of the United States Leadership Against 24 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 25 U.S.C. 7631) is amended by striking subsection (d). 26 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 23 •HR 3117 IH SEC. 312. REPEAL OF LIMITATION ON USE OF FUNDS FOR 1 ASSISTANCE FOR SEX WORKERS. 2 Section 301 of the United States Leadership Against 3 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 4 U.S.C. 7631), as amended by section 311 of this Act, is 5 further amended by striking subsections (e) and (f). 6 SEC. 313. REPEAL OF REPORTING REQUIREMENT ON AC- 7 TIVITIES PROMOTING ABSTINENCE AND RE- 8 LATED ACTIVITIES. 9 Section 403(a)(2) of the United States Leadership 10 Against HIV/AIDS, Tuberculosis, and Malaria Act of 11 2003 (22 U.S.C. 7673(a)(2)) is amended— 12 (1) by striking ‘‘(2) PREVENTION STRATEGY.— 13 ’’ and all that follows through ‘‘In carrying out para- 14 graph (1)’’ and inserting ‘‘(2) PREVENTION STRAT- 15 EGY.—In carrying out paragraph (1)’’; and 16 (2) by striking subparagraph (B). 17 SEC. 314. EFFECTIVE DATE. 18 This subtitle and the amendments made by this sub- 19 title— 20 (1) take effect on the date of the enactment of 21 this Act; and 22 (2) apply with respect to funds made available 23 to carry out the United States Leadership Against 24 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 25 VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS 24 •HR 3117 IH or any amendment made by that Act on or after 1 such date of enactment. 2 TITLE IV—DEFINITIONS 3 SEC. 401. DEFINITIONS. 4 In this Act: 5 (1) APPROPRIATE CONGRESSIONAL COMMIT- 6 TEES.—The term ‘‘appropriate congressional com- 7 mittees’’ means— 8 (A) the Committee on Foreign Affairs and 9 the Committee on Appropriations of the House 10 of Representatives; and 11 (B) the Committee on Foreign Relations 12 and the Committee on Appropriations of the 13 Senate. 14 (2) AIDS.—The term ‘‘AIDS’’ means the ac- 15 quired immune deficiency syndrome. 16 (3) HIV.—The term ‘‘HIV’’ means the human 17 immunodeficiency virus, the pathogen that causes 18 AIDS. 19 (4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ 20 means, with respect to an individual, an individual 21 who is infected with HIV or living with AIDS. 22 Æ VerDate Mar 15 2010 23:11 Sep 18, 2013 Jkt 029200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6301 E:\BILLS\H3117.IH H3117 emcdonald on DSK67QTVN1PROD with BILLS