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1 1 (March 29, 2024)

handle is hein.crs/goveouw0001 and id is 1 raw text is: Con gre sWonaI Research Se informing I hej legsive deb)ate sne I1914 0 Updated March 29, 2024 PEPFAR Extension Act of 2018: Extended 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 an expiration date, several provisions do expire if not regularly reauthorized. These provisions were most recently extended, through March 2025, in the Further Consolidated Appropriations Act, 2024 (P.L. 118-47). 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-Reiated 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 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. The PEPFAR Extension Act. In 2018, Congress enacted the PEPFAR Extension Act of 2018, P.L. 115-305. 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. 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 also extended through 2024. Global HIV/AIDS Provisions in the FY2024 Further Consolidated Appropriations. On March 23, 2024, Congress enacted and President Joe Biden signed into law the Further Consolidated Appropriations Act, 2024, which included an extension of the above-mentioned PEPFAR- related provisions through March 25, 2025. 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:

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