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1 1 (July 28, 2023)

handle is hein.crs/govemjn0001 and id is 1 raw text is: Con gre sWonaI Research Se informing I hej legsive deb)ate sne I1914 0 July 28, 2023 PEPFAR Extension Act of 2018: Expiring Authorities Since the 108th Congress (2003-2004) enacted legislation to authorize multiyear funding for international HIV/AIDS, tuberculosis (TB), and malaria programs, including the President's Emergency Plan for AIDS Relief (PEPFAR), successive Congresses have debated extending some of those authorities. While most PEPFAR-related provisions are authorized in statute without expiring authorities, the 118th Congress is currently considering whether to extend PEPFAR-related provisions in the PEPFAR Extension Act of 2018 (P.L. 115-305) that are set to expire on September 30, 2023. Whereas the PEPFAR program was the George W. Bush Administration's clarion call for confronting the global HIV/AIDS crisis, Congress has used a series of laws, as described below, to outline its vision on how the United States should fight HIV/AIDS worldwide. This In Focus describes how these acts shape U.S. international HIV/AIDS assistance, including PEPFAR. PEPFAR-Related Legislation Authorization for PEPFAR activities is provided through a number of acts, as described below. None of the acts authorize PEPFAR explicitly, rather they authorize support for international HIV/AIDS assistance. The acts outline congressional priorities on how this aid is to be provided. The Leadership Act. In January 2003, President George W. Bush announced PEPFAR, the largest bilateral HIV/AIDS program in the world. Later that year, Congress enacted the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act), P.L. 108-25, which authorized $15 billion to be spent from FY2004 to FY2008 on bilateral and multilateral HIV/AIDS programs under the PEPFAR umbrella, as well as tuberculosis (TB) and malaria programs. The act included language that instructed how the funds were to be spent, listed program goals and targets, and authorized the establishment of the Global AIDS Coordinator and the Office of the Global AIDS Coordinator (OGAC). The Global AIDS Coordinator determines how PEPFAR funds are to be distributed to the implementing agencies and certifies that congressional directives, such as those related to U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), are followed. The Lantos-Hyde Act. In 2008, Congress enacted the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act), P.L. 110- 293, which amended the Leadership Act to authorize the appropriation of $48 billion for global HIV/AIDS, TB, and malaria efforts from FY2009 to FY2013. Among other things, the Lantos-Hyde Act (primarily through amendments to the Leadership Act) created frameworks for how the funds should be spent and established program goals and targets. PEPFAR Stewardship Act. In 2013, Congress enacted the PEPFAR Stewardship and Oversight Act of 2013, P.L. 113- 56. Unlike its predecessors, this act did not authorize a specific appropriation for global HIV/AIDS, TB, and malaria programs. It focused primarily on enhancing oversight for related programs; preserving requirements to apportion 10% of HIV/AIDS funds for orphans and vulnerable children (OVC); mandating that more than half of related funds be spent on HIV/AIDS treatment and care; and requiring that at least 50% of prevention funds be used for activities that promote abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction. PEPFAR Extension Act of 2018. On November 13, 2018, the House passed H.R. 6651, the PEPFAR Extension Act of 2018. The bill was agreed to in the Senate on November 28 and presented to the President on November 30. President Donald J. Trump signed the bill into law on December 11, 2018. The act did not authorize specific appropriations levels, but it extended several provisions of the prior acts through September 30, 2023, including those requiring * the Inspectors General of the Department of State, Broadcasting Board of Governors, HHS, and USAID to jointly coordinate annual plans for oversight activities; * U.S. Global Fund contributions not to exceed 33% of all contributions received and allowing withholding portions of those contributions; more than half of U.S. international HIV/AIDS appropriations be used for treatment of HIV/AIDS and other associated opportunistic infections, as well as nutritional support and medical care for people living with HIV/AIDS; and * at least 10% of bilateral HIV/AIDS funds be used on care and support for orphans and vulnerable children. In addition, a provision requiring the Global AIDS Coordinator to publish annual reports on HIV/AIDS spending by the U.S. government, the Global Fund, and governments in partner countries was extended through 2024. Selected Enduring Provisions The overall framework of U.S. international HIV/AIDS assistance, as presently provided through PEPFAR, is enacted in law mostly without sunset provisions. As a result, these provisions remain in effect without the need for periodic reauthorization. They include the following: * Authorization of Global HIV/AIDS Assistance. Section 104A of the Foreign Assistance Act of 1961, P.L. 87-195, as amended by the Leadership Act,

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